At our facility many years ago, we were taught after access to NS flush prior to aspirating for blood return. I can not find a reference to support that practice. We are updating that guideline, and of course everything now recommends aspirate first. I am curious if anyone else experienced this change, and was there evidence or research to support the previous practice?
Are you using prefilled flush syringes? If so, they are in a clear cellaphane overwrap, meaning that the sterile part is the fluid pathway. When you attach and aspirate first, you are pulling the plunger rod back into an area of the syringe barrel that is clean but not guaranteed to be sterile. So flush a few mLs in first, then aspirate and flush the rest in. By doing it this way, the tip of the plunger rod stays within the original fluid pathway. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We use sterile flushes because we couldn't figure out a way to call this a sterile or even aseptic procedure and still drop the cellophane-wrapped flushes on our field. I guess the additional benefit is that can aspirate first (without guilt) since even the syringe is sterile. The thing is that initial flush, even if it's only 1ml or less, can often tell you if you are in the port before you even pull back, i.e., if you can't even flush that much you either have a horribly occluded port or you're not in. IMHO.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
The whole syringe is sterile in the packaging your are talking about. So the entire syringe barrel would be sterile, and my issue would not apply. There is no research on the question of aspirate first vs flush first. So the issue I mentioned with the sryinge barrel is the only reason I can think of to flush first then aspriate. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
When you have a prepackaged saline flush wrapped in a clear, but flimsy cellaphane, the only thing that is sterile is the saline inside the syringe. You cannot drop it onto a sterile field. This clear wrapper is merely a dust cover.
The outside of its package will usually warn you to NOT place it onto a sterile field.
Prefilled Saline syringes which are allowed onto a sterile field will usually have a clear top and then a paperback bottom. They will clearly denote whether or not it is appropriate to place onto a sterile field.