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.
I'm glad you revived this thread from 3-4 years ago!! It's sad that ANYONE would cut corners and jeopardize patient safety to line the pockets of their employer. Today on our Nevada Public Radio, the discussion about this incident and its legal ramification included two class action lawyers. One was agruing that this happened because the anesthesia was given by nurses, not anesthesiologists. He said that they have a bad track record and that they are easily pressured by MDs. I tried calling in to refute that argument, cause there have been recent cases in NY state of MDAs doing the same thing, it has nothing to do with training, we all are trained and taught to know this is not good practice. Whether we follow through is a matter of concern for patient safety. It all still applies.
I'm not an anesthesia provider, just a nursing student (who is looking into going to CRNA school someday), and I find this discussion interesting. I have noticed several nurses on the floor who reuse those pre-filled saline syringes to flush IVs. For example, if they don't use all of the solution in the syringe, they recap it and put it in their pocket to use for another patient. Or they leave it in the patient's room to use again on the same patient. I feel like an idiot for not realizing at the time that this was not safe or best practice. Thanks to the OP for bringing this up, and I'm glad I could learn something today.
The practice of reusing syringes doesn't make sense to me anyway, because it's not as if the money is coming out of the nurse's pocket by using a new syringe!
I have noticed several nurses on the floor who reuse those pre-filled saline syringes to flush IVs. For example, if they don't use all of the solution in the syringe, they recap it and put it in their pocket to use for another patient. Or they leave it in the patient's room to use again on the same patient.
Are you freakin' kidding me? That's horrifying! What is wrong with people? I had no idea how widespread these dangerous practices were!
I remember when I was a nursing student, I stuck myself with a clean needle that was attached to a syringe of some med I'd just drawn up. I remember my instructor saying I should just change the needle, but even as a student, I remember thinking -- isn't that potentially risky? Not that I had any blood-borne illnesses at the time (sort of beside the point) -- I just remember thinking that maybe a drop of my blood got wicked up the bore of the needle into the syringe. I can't remember what I did; hopefully I did the safer thing and wasted the med and started over.
I am simply horrified to think that this situation is more than just a few bad apples engaging in unsafe practices.
healthcare providers (doctors, nurses, and anyone providing injections) should never reuse a needle or syringe either from one patient to another or to withdraw medicine from a vial. both needle and syringe must be discarded once they have been used. it is not safe to change the needle and reuse the syringe – this practice can transmit disease
Hi, I'm an ICU RN, and a NA school applicant (should find out any day now).
I want to ask about a pretty common practice I've seen in my unit. A nurse will draw up a medication and mix it in a 10cc NS syringe, label it, and place the unused portion in the patient's bedside drawer to be used on the same patient later. It is usually a PRN morphine or ativan.
I guess the rationale for this is that often these patients are in severe pain/ distress and may have these meds ordered Q 1-2 hrs. The Pyxis is quite a long walk from some of the rooms on our unit.
Specializes in Vents, Telemetry, Home Care, Home infusion.
the aana refused to put its head in the sand when, in 2002, a hepatitis outbreak in norman, okla., was traced back to a nurse anesthetist supervised by an anesthesiologist at a hospital outpatient clinic. more than 100 patients who were treated at the hospital were diagnosed with hepatitis b or c (although it was impossible to determine precisely how many patients were infected prior to treatment or during treatment at the facility).
in response to the situation in norman, the aana took immediate action. crnas across the country were mailed a copy of the aana infection control guide along with a letter reinforcing the importance of strict compliance to ensure patient safety. press releases were disseminated to educate, inform, and reassure the public about safe injection practices. the aana also hired a research firm to conduct a random telephone survey of crnas, anesthesiologists, and other clinicians to learn more about practices and attitudes on needle and syringe reuse
because it is not always possible to identify all patients who have a bloodborne pathogen, every patient must be treated with the same pre- cautions. these include but are not limited to the following:
strict adherence to infection control procedures and standard precautions is required.
multiple dose vials should be limited to a single patient use unless strict aseptic technique is used and a new sterile syringe and access device are used each time the vial is penetrated. the danger of cross-contamination from multiple dose vials used for more than one patient must be weighed against any cost savings.5,6
properly dispose of all needles and syringes after use. do not reuse needles and syringes. once used, all needles and syringes are contaminated. they are single-use items.5,6
do not recap needles, purposely bend or break them by any means, remove them from disposal syringes, or otherwise manipulate them.5,6 an exception to this requirement may be made in circumstances in which the employer can demonstrate no feasible alternative. needle recapping may be accomplished by using a mechanical device or a one-handed technique.
place contaminated needles and syringes in a readily available puncture resistant container that is leak proof. it shall be color-coded to demonstrate that a biohazard is present.
contaminated needles and syringes should be contained in an appropriate receptacle at all times. the receptacle should be stored upright and disposed of in accordance with the facility's hazardous waste program.
alternatives to the needle-stick test are available to determine the level of a regional anesthetic and include: a peripheral nerve stimulator, a tactile stimulation device, or a special temperature sensor. if needles are used, they must be considered contaminated and disposed of in the appropriate manner.
the use of sterile, disposable equipment for performing regional anesthesia is recommended. there is limited economic incentive for processing reusable regional anesthesia trays.
ampules should be appropriately cleaned prior to opening. their contents should be aspirated with a filter needle, which is removed prior to administration.
cleanse rubber stoppers of vials prior to each use. only sterile access systems should be used for each penetration of the stopper.
do not reprocess for multiple use any intravenous fluids, tubing or other intravascular infusions or connectors that are single-use disposable items. this includes transducers, tubing, and other items that make contact with the vascular system or other body compartments. stopcocks and injection ports are major sites of contamination. when administering medications intravenously, all access portals must be maintained with sterile technique.
intramuscular, intravenous and subcutaneous routes of drug administration require appropriate aseptic technique. disposable syringe and needle systems that incorporate a protective sheath to prevent injury from an accidental needle stick are available for parenteral administration of drugs.
Since the AANA sent this advisory to all CRNA's, what else can the profession do regarding nurses who ignore professional standards??
What would you suggest besides getting rid of them? Several of the CRNA's in Las Vegas have already surrendered their licenses - rumor is that the AANA has the capability to revoke their certification, but I'll defer to those who actually have access to the policy manuals for the AANA.
austinrobi
5 Posts
Oops....(that's in case this is a repost: My 'puter burped just before I hit "send.")
http://www.lasvegassun.com/news/2008/feb/29/clinic-cut-corners-profit-critics-say/
This current case is very sad, and does not bode well for any one involved.
Does anyone know just WHEN the universal precautions took effect?
It is tragic that this lesson hasn't been learned yet.