JCAHO & Interventional Radiology

[mike151]

Hi

I work in an Angiographic suite located in the interventional radiology area. I have questions about the use of syringes on a sterile field.

I have been told that I cannot use pre-labeled syringes during a case.

Here is my problem:

If I draw up 8ml of x-ray contrast in a 10ml syringe and then label the syringe, I have an acceptable "good and proper" filled syringe. After delivering the contents of this same syringe, it then becomes an "empty pre-labeled" syringe.

As I understand it, this "empty pre-labeled" syringe cannot be re-filled with contrast.

Is this accurate?

A typical case will involve the injection of approx. 80ml - 90ml of contrast; 3-5mls at a time. This means that during the case I will have to fill, label, inject and discard about 30 syringes.

I will also inject about 3-5mls of heparinized saline after each contrast injection. This means that I must also fill, label, inject and discard about 30 saline syringes.

Do I understand this recommendation correctly?

Is it really necessary for me to fill, label, inject and discard over 60 syringes to be in compliance with JCAHO recommendations? How are you handling this problem at your hospital?

Thank you for your help.

Mike

[Altra, BSN, RN]

Off the top of my head, I don't know if you can re-fill previously used syringes in the World According to JCAHO.

But also off the top of my head ... if it were me ... my first thought would be to draw up the contrast & saline in large syringes (60mL) and dose it a little at a time as appropriate. I can't imagine the amount of time you must spend drawing up meds during a case.

[mike151]

Hi

Thanks for the quick reply. I'm afraid that contrast media is just too viscous for large syringes. You need a small diameter syringe in order to generate enough force to inject through a 5fr angiography catheter. When using a 3fr catheter for super selective embolization procedures (such as a patient actively bleeding internally from a ruptured mesenteric artery) it is necessary to use a 1ml syringe in order to create the sufficient amount of force.

Using the mesenteric embolization procedure as an example, it is common to keep about five 1ml syringes on the sterile field and repeatedly refill these five syringes throughout the case, which can sometimes last 2-3 hours and call for many, many injections. There is also some urgency in these situations as the patient has usually lost a great deal of blood by the time they get to us and they are still actively bleeding. The time it would take to fill, label, inject and discard multiple syringes could possibly be more time than the patient has left.

Thanks for the suggestion....all ideas are welcome.

Mike