Thanks, Halle for pointing out this problem. As I normally hold the plunger
as I disconnect the flush syringe, I hadn't realized this was such a
widespread problem. Thanks to all the others on this listserv who pointed
out the differences in the various types of prefilled syringes out there.
We've been struggling for the past 6 months trying to implement MaxPlus with
NS flush/lock only with a transition from Groshong PICCs to 60% PowerPICCs
with mixed results. I keep hearing about clotting problems, some areas are
worse than others, and home care is very frustrated.
Things are definitely better housewide compared with early summer, but we
still have room for improvement. I love technology that addresses these
very small details that are nearly impossible to teach every clinician out
there who uses catheters, but make it nearly foolproof to prevent problems.
This syringe discussion got me moving yesterday and I've switched my whole
agenda for my VAD Committee meeting next Thursday. We're moving this topic
up to the TOP of the agenda. I'm getting excited that this other piece of
the puzzle (too many clotted lines) may be solved with a change in product!
Of course, there are many causes and technologies around this topic, but
this is an important one.
I always learn something new on this listserv!
Nadine Nakazawa
From: "Lynn Hadaway" <[EMAIL PROTECTED]>
To: "Hallene E Utter" <[EMAIL PROTECTED]>, [EMAIL PROTECTED]
Subject: Re: Prefill syringes & backflow
Date: Wed, 18 Oct 2006 15:53:07 -0400
You are talking about the syringe rebound problem that occurs with
traditionally designed syringes. When you flush all the fluid into the
catheter, the gasket at the end of the plunger is compressed. Then you
release the pressure on the syringe plunger,causing the gasket to expand
and pull fluid back into the syringe barrel. Blood is also moving back into
the catheter lumen at the same time. Traditional syringes were not designed
with the physics of flushing catheters in mind. You are correct - we do not
know if a positive displacement connector will have enough fluid
displacement to overcome syringe induced reflux as well as the
disconnection reflux.
There are 2 ways to handle this issue.
1. use a syringe designed to prevent this problem. There are 2 on the
market, one by BD and one by Tyco Kendall
2. do not completely flush all the fluid from the syringe to avoid
compressing the gasket on a traditional syringe.,
Lynn
At 8:13 AM -0600 10/11/06, Hallene E Utter wrote:
Has anyone else had problems with the prefills "backing up"? What I mean
is after you remove the cap and push the fluid up to the tip, if you take
your thumb off the plunger for an instant, the plunger and fluid slip back
a bit. This is not so significant before you flush in terms of a
significant amount of air,esp in adults, but if you are using a neutral
displacement valve cap and you release your thumb from the plunger before
you unscrew the last syringe (which would be normal in my opinion), it
allows for blood to back up in the tip of the line. Even with a positive
displacement cap, I am not sure the over flow with unscrewing is adequate
to flush this backflow back out of the tip thoroughly. Particularly
important if only using saline flushes. Anyone else seen this phenomena?
Even clamping before you unscrew, unless you keep your thumb and hencefore
pressure on the plunger, would not prevent this "plunger slippage". Any
comments? I had the ICU nurses point this out to me and they were sure
right. The fluid slips right back into the syringe after you push it up
to get ready.
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
