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Laurie McCulloch
Prefilled Normal Saline Syringes

I hoped those using Prefilled normal saline syringes could comment on a concern brought to my attention:

We are considering bringing in Prefilled normal saline syringes with Internal Sterile pathway only. The concern is that the external portion of the plunger is extended into the clean packaging. The plunger would then be considered clean, 'not sterile' and the reintroduction of the plunger backward and forwards during the checking for blood would/could contaminate the solution.

Nurses are asking.....should we be drawing back to check for blood returns with these sterile pathway syringes? I'm not hopeful that the manufacturer will be very much help.

Anyone? Thoughts

Laurie McCulloch, Nurse Clinician IV Teams Victoria, B.C.

lynncrni
I addressed this in an

I addressed this in an article in Infection Control Resources. You are correct that the fluid pathway is the sterile component and the segment of the barrel behind the plunger gasket would be considered clean and not sterile. There will be an air bubble inside that must be pushed out. This would provide a small area for you to pull back to check for a blood return. This should give you maybe the distance of about 1 mL to check for a blood return. The biggest risk is when you use a prefilled syringe to squirt out part of the fluid, then add another drug to dilute it with the saline. This is not recommended by any of the prefilled manufacturers because you are going back and forth and moving the plunger into the barrel area farther than the manufacturer recommends. There has not been an infectious outbreak reported with prefilled syringes that are terminally sterile. There have been outbreaks reported with those that are aseptically filled. Terminally sterile syringes are filled, then sterilized, then packaged. Aseptically filled syringes are filled with sterile fluid but there is no additional sterilization to them. Those that are completely sterile are filled, packaged and then sterilized. In addition to the possible risk for contamination, adding a drug is not recommended because the label can not be changed to indicate the added drug, creating a huge risk for med error. 

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gwen Irwin
It is my understanding that

It is my understanding that using the prefilled syringes for medication dilution is definitely off label use and not supported by the manufacturers of the prefilled saline syringes, due to the rixk of contamination during pulling back into the area that is not considered part of the internal sterile pathway.

We had a big learning curve for the nurses to understand that these syringes were for flushing only and not for pulling back.

We have had selected units chosing only the sterile packaging, like Lynn refers to, to have on their unit.  Most of these units are Intermediate Care or ICUs.  Of course, this incurs an aditional expense.

Gwen Irwin

Austin, Texas

lynncrni
There are 2 additional risk

There are 2 additional risk with using a prefilled syringe for diluting drugs - the saline label can not be changed to indicate that a drug has been added plus the gradation markings on these syringes are different than a regular 10 mL syringe. On the prefilled, they are marked at 0.5 and 1 mL only, not the 0.2 mL  like a reguluar syringe. Both of these factors could lead to medication errors. ISMP has warned about these issues. 

 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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