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port access
Ok am I being to picky.  It drives me crazy to see that ports are being accessed using prefilled non sterile saline suryinges.  They are keeping the non sterile syringe off of the field, but to me when you access and then have to flush, you are now dirty and then have to apply your dressing.  I was taught long ago to drop a sterile syringe and draw up sterile out of a bottle.  Am I being a little to over kill for questioning this?  Susan
Are you talking about

Are you talking about flushing a PICC during the insertion procedure? Or are you talking about flushing an implanted port when you access it? The first procedure requires a sterile syringe dropped on to a sterile field. Filling the tubing of a port access needle, then performing the access procedure and flushing with the a regular prefilled syringe can be done if you know what to do. Know what is sterile and keep what is not sterile away from what is sterile. You could use a one-sterile glove technique to flush the line before access - one hand with a sterile glove to hold the access needle and one ungloved hand to attach the prefilled syringe. Then put a sterile glove on the second hand to stabilize the port body after skin prep. Although this hand has a sterile glove, it is no longer considered sterile because it has touched skin which can never be made sterile. So I don't see a problem with using a regular prefilled syringe for this procedure as long as the nurses can master this skill. 

 All prefilled syringes are not processed the same. There are 3 methods - aseptic filling, terminal sterilization, and total sterilization. Aseptic filling is bring sterile products together, filling the syringe, capping, and packaging and shipping to you. No further sterilization is done. Terminal sterilization is filling and capping, then sterilizing, then packaging and shipping. This results in a product where the fluid pathway is sterile but nothing else. Total sterilization is filled and capped, packaged and then sterilized. This results in a product where all areas of the syringe and fluid are sterile. Neither of the first 2 are labeled for dropping onto a sterile field.  


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

They are not using the
They are not using the sterile syringe at all.  The are placing the non sterile flush off of the sterile field and connecting it to the tubing of the port before they get sterile, which technically gets a small end of the port tubing contaminated.  I agree as you said, it can be done, but is it really?  I have just redone the policy resently to say to drop a sterile syringe and use a saline bottle, but I suppose more education is needed.  Thanks for your thoughts.  Susan
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