I am looking for feedback from hospital-based nurses about the processes, methods, and criteria used to justify the use of prefilled syringes for catheter flushing in your facility. What were the clinical factors? What were the financial issues? What impact did labor costs have in this decision? Did the legal issues have a great impact, with all organizations emphasizing single-dose systems now? Please let me know what you found to be the most beneficial to justify using prefilled syringes for catheter flushing. Or if you are still working on this - what have you found to be the barriers, or problems with bringing in prefilled flush syringes. Thanks for your comments.
In our Trauma level 1 public hospital (300 beds) we changed to pre-filled syringes in 2005 when we found that the Multi use IV bag of NS hanging in every medication room was not used correctly in that nurses were not labeling the date and time the bag was first accessed. We found the pin allowing access to the bag not covered some time. Some nurses were fogeting to fill the syringe prior to cominig into the patient's room to flush the IV before and after intermittent infusion.
ID got involved and we decided to switch to pre-filled syringes, everone LOVES IT and we found the nurses to be much more complient with flushing.
We now charge individually for every pre-filled syringe we use (not that it makes a difference since almost all our patients are uninsured).
Still looking for more feedback on the clinical and financial decisions about prefilled syringes for catheter flushing.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
For many years at the hospital I work, we had pre-filled 3ml size NS for flushing of PIV's and pre-filled Heparin (100units/ml) with 5ml total (500units) in a 10ml size syringe that was used for central lines including the PICC lines that we had used for many years that were open ended non-valved catheters. When we switched over to the Boston Sci Vaxcel-PASV PICC line in March of 2007, we found that the nurses in general were flushing these PICC lines with the 3ml size pre-filled NS syringe. With this being said, all of nurses were educated on the care and maintenance of the new PICC line which included a NS only flush and that they were not to use a syringe size less than a 10ml size. These nurses were instructed specifically to draw up 10ml of NS separately since we did not have a pre-filled 10ml size NS syringe available. This continued to be a problem and it was found that the main reason was the time and convenience factor. The bottom line was, the nurses were always pressed for time and the pre-filled was easier to grab then the time it would take them to draw up the NS manually. I even questioned a nurse when I was in a patients room one day on daily PICC rounds and saw her ready to flush the PICC line with the 3ml pre-fllled in hand ready to go. I stopped her and asked her if she realized what she was doing, and she admitted that she new exactly what she was doing and that it was the wrong practice but that she was so behind and the convenience of the pre-filled syringe won out. After that encounter, I met with the head of Pharmacy and explained my position/proposal and asked what it would take to make the switch. With the support of the Pharmacy Director, the switch was made totally in about 3-4 weeks. The only units that did not make the switch and stayed with the 3ml size were Peds, L&D and the post-partum departments. The cost eneded up not even being a huge factor.....something like 30cents more.....so little that I was upset with myself for not proposing this way sooner. Anyway, our hospital totally did away with the 3ml size of pre-filled NS syringes except for the departments mentioned previously and only use the 10ml NS size with PIV's, PICC lines and all other central lines. The nurses housewide were thrilled with the switch and it is a good feeling to know that this aspect of flushing PICC and central lines is within the standards of practice once and for all. I hope this helps Lynn.