I am seeking information about your issues, challenges, concerns, and questions about using prefilled syringes. Are there specific issues with prefilled saline syringes or heparin lock solutions for flushing catheters? Are the problems with these flush syringes different from other prefilled medication syringes? Any comments will be greatly appreciated. Thanks, Lynn
The only issue that we had was the "fluid path" was sterile, but not the rest of the syringe. We found that nurses were wasting saline and the drawing up medications, so it could be given in a dilution of ?ml/10ml. When consulting with the manufacturer, it was considered off label, so nurses had to be retrained not to do that.
Gwen Irwin
Austin, Texas
We love the (non sterile) 10cc pre-filled syringes with the female luer lock cap on them, because they can "cap" the IV tubings that is being removed from the PICC to put it at "stand by" until the next need to infuse.
The use of the pre-filled syringes made all the bedside RN so happy, they flush more frequently which in turns reduces catheter occlusions.
We like the non sterile pre-fill syringes. I too like that the cap fits on the IV tubings so to minimize potential contamination vs staff inverting the ends of their tubings into the y port on the tubing. It is definately a nice handy, easily accessible sterile cap!
We are using the re-designed 5 ml ns pre fills. The syringe is smaller supposedly taking up less space, but has the same PSI as the 10ml.
One issue would be staff thinking they can unwrap several syringes at a time and use them through the day... this is not recommened by the manufacturer and would not guarantee its safety. Also they are not sterile syringes and could not be placed on sterile fields. It is written clearly on the individual packaging.
I do believe one of the JCAHO patient safety goals is to label syringes with the medication. If staff are pulling up meds in a prefilled syringe labeled sterile saline by the manufacturer and set it down for some reason another staff member may use it. Odd things have happened.
One issue we have found with the smaller ns pre-fill, if we want to use the full 5ml for a 2nd turbulant flush with a CVC in trouble shooting a blood return, you cannot pull back on the smaller syringe unless you have strong fingernails to slip in under the lip of the plunger. I've personally gone to a regular syringe and draw up my ns when trouble shooting CVCs.
Hope this helps Lynn ~
Ann Zonderman, BSN, JD, CRNI, LHRM
I am reading a rather disturbing trend in this "re-use" of the caps from the prefilled syringes. The product clearly is labled for single use only... Reuse is a sloppy nursing practice, just as placing the tubing tip in the upper injection site on the tubing. Always have a new sterle cap to place on tube tips.
The package on the NS flush my company uses states "Single use. Discard unused portion. Solution and pathway are sterile. NO notation that the cap will be sterile for reuse..
I also note many nurses flush with some of the NS and want to save and use the rest later.... NOT !!!!! again - single use, and potential for contamination.
How would anyone defend themselves if JCAHO or state surveyors observed this practice... Why are nurses risking patient comprise and potential action against their license for negligence...
Ann Z
Ann Zonderman, BSN, JD, CRNI
I agree with you Ann on all points. Thank you. Unfortunately the use of the injection ports on the tubings seems so broadly used. I've gone to the INS standards as my resource to defend sterile caps but they did not address it. I thought they had at one point but just this year when I needed that reference several of us looked for it without success.
Again, thank you Ann for your comments! :)
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hello, Im new here and i would like to get some ideas regarding the 10 cc NS prefilled (non sterile) syringes.
Is it ok to unwrap them and get them ready with the luer lock connector caps, using no touch technique. And connecting the white cap in the end to maintain aseptic technique?
Is there any standard of practice regarding that? It does say "do not drop in sterile feild", so i dont see the difference between opening them ready and not.
Thanks
A prefilled syringe in a cellophane overwrap is sterile in the inside fluid pathway and under the syringe tip cap on the male luer end. They cannot be placed on a sterile field as the outside is not sterile. You have to protect the sterile components. That means removing the tip cap immediately before you are ready to use it. Do not remove that tip cap prematurely or remove it and allow the male luer tip to contact any surface until you are ready to attach it to a the connection surface of a needleless connector that has been thoroughly disinfected. I don't really understand what you are asking for sure. If you are asking about their use immediately before you insert a PIV, you can assemble the extension set, needleless connector, and prefilled syringe and use the saline to prime this system. Do NOT detach anything, leaving this completely assembled. When the PIV is in place, remove the tip cap from the extension set, attach it to the catheter hub and flush the catheter. If the catheter is already in place and you are using the prefilled syringe to flush the line, disinfect the needleless connector and do not allow it to touch anything, remove the syringe tip cap and attach and flush. Do NOT use these syringes for diluting any medication. When using, push forward to flush a small amount first, then aspirated for a blood return and finish flushing. Do NOT pull the plunger back into the space in the syringe barrel behind it original position as this space is not considered to be sterile in these syringes. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you!
I guess my question is, is it ok to remove the overwrap ahead of time to assemble the flush with the needleless connector (luerlock) and attach the syringe tip cap to the other end of the needle less connector, all while observing sterile technique, and carry it around in our IV cart?? We sometimes do this to save time. since we use the Saf-T-Intimas mostly, that's why we get these ready ahead of time.
But thank you for the explanation. I appreciate it very much.
Anton Cortes RN VA-BC
No, there are several problems with this. First the syringe tip cap is a single use device and must be discarded after it has been removed from the syringe. It can NOT be reused in any way. Second, USP 797 requires no more than 1 hour of preparation before a fluid/medication is used. So attaching this on multiple sets for an entire shift would be in serious violation of this national regulation. You must prepare immediately before you are ready to use them. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861