irrigating saline vs iv saline

[Triagn]

We have always used the bottled irrigating saline on our back table. There are times that we add heparin for irrigating vascular cases. We have contacted Abbott and they have essentially told us that the solutions are the same and that the labeling is different for three reasons. 1) bottle are labeled for IRRIGATION only so that no one will try to spike and hang them 2) that the particulate matter is more controlled in the IV solution than the irrigating due to USP standards for IV infiltration and 3) the volume of fluid id the 3000ml bag is label for irrigation only so that someone won't try to had a 3000ml bag and not check the IV site for three days!

My question, when you decant a bag of "IV" NaCl on the field you no longer have control of the particulate matter that is in the open bowl, therefore there is no difference from the bottle or bag as you are open to the room enviornment. Who feels the same and who practices this? What do you do with lets say the hep. flush that you may use in infusaport insertions or IVC filter insertions? Do you use a closed IV system to flush after insertion of these or do you use the open bowl with heparin?

[carcha]

here in ireland we always use a bag of ns with heparin added to it pre op with 2 people checking. I think u have more control of the amount and sterility of the fluid. we use bottles of ns only for abdominal flushes, cleaning ect, ect. could be a research question

[Triagn]

WE have received information from Abbott that the two salines are IDENTICAL in composition, the difference only being the delivery system used. Obviously you cannot infuse from a plastic semi-rigid bottle. Using this saves the pt/hospital quite a bit of money especially when you have it open on your field

[Triagn]

AFter speaking with Abbott and the US Pharmocopaedia who makes the labeling, BOTH slaines are identical and the only reason for labeling it Irrigation VS. injection in this size container is the type of container. You cannot hang a semi rigid bottle so due to the vessel type it is labeled irrigation. So if you want to save some $ for this type of usage, go to bottles rather than IV bags. Check it ouT

[carcha]

would love to watch my nurse managers face if i came up to her with this. I truly think that although their identical, the difference in the packaging, method of opening and handling is the reason for the use of the iv bag during vascular cases, when your runner opens the bottle I do feel there's more chance of comprising your sterility then the bag. Definately a research question

[Triagn]

I can fax you the paperwork from USP and Abbott if that would help. Do you pour your meds in a cup or draw them up like locals?

[shodobe]

Triagn, would you please fax or give the web site so I can use this info. I would appreciate it. The number is 909-806-1079, put it to the attn of Mike Thanks!

[stevierae]

NS is NS is NS: that is, Normal Saline is 0.9% Sodium Chloride solution, PERIOD, whether it is IV or in a pour bottle for irrigation.

I have always thought it silly that some nurses insist on using IV NS for cholangiograms--why?? It is, after all, just going into the common duct--part of the GI system. They never have a rationale as to why they think it is somehow "better" to use IV NS. They always say, stubbornly "That's just the way I've always done it," or "how we've always done it here." Whatever.

Now, if you are INJECTING contrast media for an ARTERIOGRAM, of course you would want to use IV NS, as you would to flush an IV or arterial line, or to give an IV push or piggy-back med--

But, if you are irrigating a harvested vein for implantation (i.e., a saphenous vein graft to be used during a CABG) it really makes no difference if you use IV NS or pourable irrigation NS, to which you have added the appropriate amount of Heparin.

I think some people just prefer to use pre-Heparinized IV NS already added (like the one we use to set up art lines) simply because it saves the step of drawing up your own Heparin. But then, you have to add a transfer jet to the bag, so that's an extra step you would'nt have with pouring out of a bottle--

I think it makes sense to do whatever is the most cost effective and/or most time efficient at your hospital--even if you work at an HMO or a military hospital, the extra costs have to be borne by SOMEONE--

[stevierae]

Quote

Originally posted by Triagn

I can fax you the paperwork from USP and Abbott if that would help. Do you pour your meds in a cup or draw them up like locals?

Which meds do you mean? Antibiotics added to irrigating NS?

I either reconstitute them with IV fluid pulled from the patient's IV bag (I hate to waste even a 10 cc. vial of IV NS if it is not necessary; why not take it from the patient's IV?) and add them right to the pour bottle of NS via syringe, or I pour the plain NS onto the back table and have the scrub draw me up some irrigating NS (from the supply I have just poured,) then hand me the filled syringe; I then use that as my diluent to reconstitute the antibiotic, and squirt it wherever he asks me to--either in to the graduate or bowl of NS that is going to be used as antibiotic irrigation, or into a med cup that will be labelled and then added later to a fresh supply of warm NS.