It has come to our hospital's attention that the fluid pre-filled flush syringes that are in a "dust cover" rather than a sterile package can become contaminated when pulling back the plunger to the very end of the barrel bringing the fluid into contact with a clean but not necessarily sterile area. Considering that the general practice is to aspirate a blood return before flushing, how should this be dealt with? The use of sterile packaged prefilled syringes would increase costs greatly I'm certain. What is your facility doing in regards to this. Thanks. Input is greatly appreciated! Siri, Manchester NH
One should not be pulling back on the non-sterile prefilled, syringes to break their heat seal, or to hook up to the catheter and immediately check for the blood return. What we do is flush approx 2 cc of a 10cc prefilled saline syringe into the catheter and THEN pull back to assess the blood return. The saline in a non-sterile, prefilled syringe wiht a dust cover has only the sterile saline sterilized. Therefore, one should NOT be pulling the saline into a part of the syringe which hasn't been in contact with the sterility process. Check BD website for their posiflush syringes.
The prefilled syinges you are describing are known as "terminally sterile" by the FDA. The syringe is filled with saline, then the sterilization occurs, then the dust cover is added. The saline and fluid pathway is STERILE to a very high standard established by the FDA. Due to the cellaphane dust cover, the small portion of the syringe barrel behind the plunger rod can't be called "sterile" althought it was originally. This is the most common method for packaging prefilled flush syringees and their use is far safer than batch filling in the pharmacy or filling an individual syringe be the nurse at the bedside. The correct way to use these commerically prepared prefilled syringes is to flush a small amount into the line first to assess for resistance, then aspirate for a blood return, then flush the remainder into the line. It is best if you do not aspirate beyond the original position of the plunger rod, however these syringes and this filling process has been used for about 15 years and there has not been any infections reported due to this. There have been infections reported from other filling methods though, usually known as an aseptic filling. In this process, sterile saline is filled in a sterile syringe and then placed in a dust cover. No additional sterilization is done once the saline is in the syringe. This aseptic filling process is the same as what you or a pharmacy tech would do to fill a syringe. Terminal sterilziation is safer by far, IMHO. 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