Pre-spiking IVF

tokmom, BSN, RN · May 18, 2011

Being from the stone age, what is pre spiked and how is it packaged?

EmergencyNrse · May 18, 2011

Depending on what you're doing with the IV fluids why are you so worried?

You have seen too many movies if you think there are people sneaking around in the corners injecting poisons in your IV fluids when no one is looking. Somehow they are trying to trap you into hanging something bad and then you would be responsible for the outcome?

I have worked many centers where we routinely had about 20 bags of .9% NS that we put together before daily surges. Most people were going to receive IV therapy of some kind or another. All are good for 24* then are usually discarded. It just helps with the flow sometimes and we almost NEVER waste an IV bag that was prepped that day. (Your par numbers might be different)

It's still up to you to verify solution, expiration dates, and to verify there are no pyrogens in solution before you start a bag.

If you're THAT paranoid is there some reason they're preventing you from just spiking your own? Not use any of the prepped ones? "Secure and Visable"...lol. I really think this is a non-issue.

LouisVRN, RN · May 18, 2011

Yeah our policy is that once spiked IV fluids are only good for 24 hours. If you are doing a lot of boluses and have a way to ensure they are clearly marked and disposed of on schedule

cjcsoon2bnp, MSN, RN, NP · May 18, 2011

I guess I'm just nieve because I never really thought this was an issue. We don't have a ton of pre-spiked bags hanging around in our department but we do use a few and as long as the bags are used within 24 hours then its never really a big deal.

!Chris :specs:

**canoehead, BSN, RN** · May 18, 2011

Does it really save that much time? I'd rather spike them fresh myself, and as a patient I'd rather the freshly spiked bag.

GHGoonette, BSN, RN · May 18, 2011

Canoehead's right, they should be prepared as and when required; I can understand that it helps to have a supply of pre-prepared fluids available when the department is hectically busy, but it's not the right way to do it.

BabyLady, BSN, RN · May 18, 2011

Who's using pre-spiked fluids? I have trouble with the concept unless the fluid is secured or visible at all times. I work in an ED and have a newer nurse pushing the concept as a "Lean" idea, but it just does not seem safe to me. Joint Commission refers to hospital policy, but we don't really have one. I've done a journal search and haven't come up with much either. What's the consensus and how do explain this? I really wanted some EBP because she doesn't really get how important that is.

What is your concern regarding safety?

You are reponsible for checking that the label on the IV bag matches the order written by the physician...if what is INSIDE the bag is not mixed properly (which would mean, right sticker, wrong drugs), then that is when the liability of the pharmacy starts.

We get pre-spiked IV fluids from pharmacy all the the time and I have no issue with the safety. I have to trust that the workers in pharmacy, who receive training on infection control, maintain the line in the same manner that the rest of us do.

Our pre-spiked fuids are for daily orders only.

brownbook · May 18, 2011

Another voice for pre-spiking IV's. They are dated and placed in the IV warmer. Good for 24 hours. This is in an out patient clinic where patients are scheduled, a more controlled environment than a chaotic ER. But I would think a few pre-spiked IV's to be used for stat emergencies would make sense.

tvccrn, ASN, RN · May 18, 2011

Who's using pre-spiked fluids? I have trouble with the concept unless the fluid is secured or visible at all times. I work in an ED and have a newer nurse pushing the concept as a "Lean" idea, but it just does not seem safe to me. Joint Commission refers to hospital policy, but we don't really have one. I've done a journal search and haven't come up with much either. What's the consensus and how do explain this? I really wanted some EBP because she doesn't really get how important that is.

Okay, I have a totally different question...what exactly is a "Lean" idea?

ObtundedRN, BSN, RN · May 18, 2011

All of our hospital's TPN and PPN comes up pre-spiked from pharmacy.

And I've seen one department that does outpatient endo procedures use prespiked NS. And that is because that department is run like a puppy mill. Constantly bringing patient's in, starting an IV, and within about an hour the procedure and recovery is over, IV out, and patient on their way home. Those pre-spiked NS bags are used up in about an hour, and then someone will spike about ten more, and then have to spike some more in about another hour or two.

etaoinshrdluRN · May 18, 2011

"LEAN" is a philosophy of simplifying operations in order to save time, errors, money. etc. "Kaizen" being the buzzword of the LEAN philosophy. But God help me, I have no idea how pre-spiking IVs is lean. Wouldn't that waste at least a few more IVs if they weren't required, after all? Could it possibly take 5 more minutes to draw a drug from the Pyxis and inject in it into the bag? ???