Using same syringes all day

[stevierae]

OK, I have wondered about this for many years, and wonder what the current thinking is.

Wherever I have worked as an OR nurse, since the early '80s, anesthesia draws up their meds in the a.m.--their succs, their vec, their roc, diprivan, fentanyl, Versed, etc--and uses the same syringes all day long from patient to patient.

This was true in the '80s when we used Pentothal and when we still utilized the amber IV ports that required needle access. They also used the same needles all day--just stuck the needle, full or partway full syringe attatched, back into the multidose vials between uses. We usually put a stopcock on for the Pentothal and the succs; nowadays, of course, the tubing comes in with a built in dual stopcock for the Diprivan and the succs, and the other meds if desired, or they are infused through other ports, which are now needleless.

Also, if they prepared a succs drip in the morning, they used it all day long, from patient to patient. I can even remember other anesthesia providers popping their heads in and saying, "Can I borrow your succs drip?" and using it on THEIR patient, rather than preparing a new one.

My question is, is this practice considered acceptable nowadays? Should it even have been considered acceptable then? In today's litigious society, it seems that that is a lawsuit waiting to happen.

I can understand the rationale, I think--since they are injecting directly into a port, and not aspirating, (they also are not aspirating from the vial; just drawing up the medication directly) there is little likelihood of contaminating the syringe of medication with a blood borne pathogen such as HIV or Hepatitis--or, is there? What if there WAS a microscopic bit of blood in the tubing that backed up into the port or stopcock, perhaps not visible as a droplet of blood but enough to contaminate the syringe containing the medication (i.e., the succs) with Hepatitis? And thus, potentially, spreading it from patient to patient?

Same thing with the drip--it is being plugged directly into a port, and the likelihood of blood flowing back into that port to contaminate the tubing (which will be reused) is minimal--or, is it? Seems to me that ANY possibility, however remote, is too much of a risk to take.

I have always worked at institutions affiliated with prestigious medical schools and anesthesia programs, so I have thought, well, if THEY do it, it must be accepted practice--but then again, you would NEVER see such a practice by an RN in the ER or the ICU--i.e., using the same Dopamine or Lidocaine drip over and over, rather than wasting it; or using a full syringe, say, of Dilantin for multi patient use until it is exhausted . Are we as RNs overly cautious, or are the anesthesia providers I have described overly reckless? These are outstanding anesthesiologists and CRNAs I am describing here and ones that are passionate about optimal patient care, so obviously they consider the practice a low or no risk one.

Thank you one and all for your thoughts.

[gaspassah]

if i'm not mistaken there was a big hepatitis outbreak somewhere because of this and it's now mandatory by jcho and osha to not reuse syringes.

i go through about 50 syringes a day, at least. i dont even like using one syringe for 2 drugs drawn up at different times.

d

[jwk]

Years ago it was common to use the same syringes all day. Often the syringes weren't even labeled - they were simply stuck back in whatever vial was being used.

That's an indefensible practice nowadays, and wasn't good practice 20 years ago either. There are studies showing microscopic blood contamination fairly far proximally in IV tubing.

Propofol is a particular concern. It is supposed to be discarded after 4 hours due to propofol being an excellent bacterial growth media. There was a well-publicized case several years ago of an anesthetist who used the same propofol syringe for several days with less than favorable patient outcomes.

[stevierae]

Years ago it was common to use the same syringes all day. Often the syringes weren't even labeled - they were simply stuck back in whatever vial was being used.

That's an indefensible practice nowadays, and wasn't good practice 20 years ago either. There are studies showing microscopic blood contamination fairly far proximally in IV tubing.

Propofol is a particular concern. It is supposed to be discarded after 4 hours due to propofol being an excellent bacterial growth media. There was a well-publicized case several years ago of an anesthetist who used the same propofol syringe for several days with less than favorable patient outcomes.

Yes, I just wrote to an anesthesiologist colleague--he told me that an anesthesia provider got fired for using a 500 ml. Propofol drip on eye patient after eye patient--3 in succession ended up with Klebsiella sepsis.

[alansmith52]

It seems like I heard that a provider was doing this last year or so and got caught and ended up loosing his liscence or somthing. again it was a midwestern state. I don't remeber the details but he had used the same needle from pateint to pateint it was all over the news.

[hypnotic_nurse]

It was here in Oklahoma at Norman Regional Hospital.

[skipaway]

I don't even use the same syringe on the same patient if I've used up all the drug and need more. I get a new sterile one and I also use about 50 per day. If you notice, the barrel of the syringe gets contaminated by your hands and if you re-draw more medicine the contaminated barrel comes in contact with your sterile drug. Re-using syringes has been a pet-peeve of mine since I was a brand new nurse (way before that hep scare)

[prmenrs, RN]

When I did Infection Control in the 70's, that was something I kept telling OR was a bad idea, could not get anyone in anesthesia to even give me the correct time on that subject--had to give up as there were lots of other brick walls around to bonk my head against--anyone who talks about the 'good ole days' doesn't know jack.....

If there are still people doing it out there, remind them that their malpractice insurance probably won't cover them for that.

[stevierae]

here is my anesthesiologist colleague's (he practices on the east coast; i practice in ca and the pacific northwest) response to to the question:

you brought up a nostalgic glimpse at the past for me when we too used to line up in the morning and pull our pentothal out of a common "well" and keep our syringes till the next day if they weren't used.

in fact, an old professor of mine who is perhaps the most profoundly intelligent physician i ever met stated that due to the high ph of pentothal, there is never any danger of bacterial growth and thus he had full syringes in his cart that were sometimes over a year old.

but...enough of that. hospital epidemiologists in the us have mandated a series of controls both for the protection of the patient and the health care personnel. needleless systems are pretty much the norm in our specialty where we inject directly into a stopcock.

the little amber ports are still there but just about never used (maybe for a piggyback iv antibiotic now and then). all drips, infusions, pressors etc. are made up either by the pharmacy or the individual anesthesia staff member fresh for unique and individual patient use only. this is a strict rule.

we had a nurse anesthetist 10 years ago who used a propofol drip on all her eye patients. well, she made up one huge bag (500 cc of d5w with propfol) and just switched it from one patient to the next. that ended (as did her job) when 3 patients in a row ended up with klebsiella sepsis from an infected bag of propofol.

these older practices are gone, and i don't think that there is a place in contemporary medical practice for any shortcuts whatsoever that may expose anyone to any degree of risk of contamination, infection, or pharmacological alteration of administered drugs or solutions.

the chance of error or other mishap is just too high and would be expected to occur as a natural consequence of such practice.

[Fergie]

Just in the last year in Fremont, Ne an oncology clinic was using the same syringes. The Dr. left the United States and has charges pending. I understand the RN has lost her liscense. Many outbreaks of hepatitis and some deaths directly related to this. Why risk using the same syringe all day? If it was your loved one how would you feel about the syringe not being changed? We as nurses have the control and have a responsibility to make certain we are doing all we can as humans and professionals to prevent and spread of pathogens.

[TejasDoc]

Check out some of these links, interesting stuff out there.

http://www.asahq.org/Newsletters/2002/12_02/greene.html

http://www.aana.com/press/2002/111302.asp

http://www.aegis.com/news/ads/2003/AD032201.html

http://www.news-star.com/stories/120802/hea_14.shtml

I think there's more out there, but this is a good start for anyone who'd be interested. Science, human interest, we've got it all. Enjoy.

TD

[versatile_kat]

Thanks for the links Tejasdoc ... the last link was especially disturbing. We should all be aware of the dangers with needle reuse (even if we think it's a moot point as healthcare providers).