tubex vs. syringe

[meaganbuck]

We have a bit of a debate going on in our ER right now. Some of the more experienced nurses don't like the idea that others are drawing medication from a tubex cartridge into a syringe as opposed to using the carpuject. For example: 2 mg of MSO4 is ordered IV for a patient. 4 mg MSO4 tubexes are available from the pyxis. Is there a safety concern when a nurse decides to pull 2 mg from the tubex into a syringe? Any research findings on this would be appreciated!

[monkeybug]

No research, but that was how we did it. Our pharmacy stocked the carpujects, but we didn't have the annoying little Tubex to use with them. And anyway, we gave the drug IV and used needleless tubing. We would take a 3cc syringe with an 18g needle, draw what we needed out, take the needle off, and then give it IV push. I never saw the Tubex used, ever, but we never had vials of medication, either.

[nurseprnRN, BSN, RN]

We have a bit of a debate going on in our ER right now. Some of the more experienced nurses don't like the idea that others are drawing medication from a tubex cartridge into a syringe as opposed to using the carpuject. For example: 2 mg of MSO4 is ordered IV for a patient. 4 mg MSO4 tubexes are available from the pyxis. Is there a safety concern when a nurse decides to pull 2 mg from the tubex into a syringe? Any research findings on this would be appreciated!

I would think this would make documenting waste a little more time-consuming. I'm not sure what you gain by doing this anyway. And anytime you break into a sterile object you run the risk of contamination. Why not just waste the 2mg out of the Tubex (this is a trade name for the little glass tubes with the drug in them and the needle on the end, not the gadget that holds them for injection; Carpujects is another manufacturer of the same thing; they are interchangeable in the injection gadgets) and give the remaining and be done with it? If you're putting it inline in an IV you don't need to worry about a needleless system to avoid a contaminated stick.

[KelRN215, BSN, RN]

Never done it any other way. We stocked carpujects but, same as monkeybug, didn't have the tubex. (I didn't actually know there was a product to use with them until reading this message board because we never had them.) Anyway, this was pediatrics and we'd have like a 10 mg carpuject of valium with an ordered dose of 2mg. Only thing to do was draw it out of the carpuject with a blunt tip needle and syringe.

[heron, ASN, RN]

The carpuject meds we stocked on the hospice intp unit actually had a needle assembly that could snap off revealing a rubber diaphragm through which we could draw meds just like any other amp.

[dudette10, MSN, RN]

I think this is a case of there being more than one way to skin a cat. FWIW, my current facility doesn't keep Carpujects in stock, so using them would mean the nurse purchased one out of her own pocket. Steths, scrubs, penlights, scissors, pens, dry erase markers, Sharpies, measuring tape, calipers, pill cutter...don't want to add another "must buy" to my list.

[ERGirl83]

In our ER, 99.9% of RN's draw the med out of the tubes and administer it with a syringe. There is one nurse who prefers the carpuject. She was trying to convert me, but I wasn't sold. I feel like I have better control over med delivery with a regular syringe, especially with a patient and drug I'm giving slowly.

[Anna Flaxis, BSN, RN]

http://www.medscape.com/viewarticle/773246_5

I really like carpujects. It saves me the step of drawing the medication up, which is really nice when time is of the essence.