Why Do Nurses Use (Stuff That Shouldn’t Be Reused) Over and Over?

Originally posted at http://onlinelpntorn.org/2014/why-do-nurses-use-stuff-that-shouldnt-be-reused-over-and-over/

So asks The Infusion Nurse Blog in a recent post. I really like this blog, by the way. The Infusion Nurse uses evidence-based practice and gives practical and timely reports and advice that nurses can immediately use. The blog is even in my Top 10 Blogs for Your Daily Blogroll (see the other nine here).

So, you've read the post? Good. Are you cringing a little bit, because at first you thought, "why would anyone do that?" and then you remembered you've done it? Kind of like when you read all the reasons not to use multiuse vials and then remember all the times you carried that extra 1 mg of Dilaudid (half a vial) around because you knew the patient would need it in an hour and didn't want to waste it? The road to hell in nursing is, I find, particularly paved with good intentions and logic that seems fairly watertight.

Some logic is not as watertight. I have thrown several miniature tantrums at three workplaces that I can think of without much effort about filter needles. Apparently I attended the only nursing school ever in the history of nursing schools that taught students about filter needles, because when I mention their use, I get the "deer in the headlights" look that Infusion Nurse often describes. It makes me twitchy and gives me a pain behind my left eye when I see someone pull a glass vial, snap the neck with their fingers, toss the cap, and pull up an IV medication with a blunt-tip. That medication is going into a patient's veins. Drawn up in this way, also going into that patient's veins are dust that was on the neck of the vial, bacteria from all over the place including your hands, and microscopic pieces of GLASS. Because you're snapping a GLASS vial. "I've always done it this way, and I've never seen any glass." Twitch.

Reusing single-use vials seems like one of those harmless things until you learn that they don't contain preservatives, so they become little bacteria swimming pools as soon as you puncture the seal, which you probably haven't wiped with alcohol because it HAD a cap over it, didn't it, and carry those bacteria into the medication (which you are going to put in a patient's veins).

Alcohol swabs? I've reused them. Don't judge me until you really think about it. If you bust out a fresh swab as you should for, e.g., drawing labs off a central line, you'll do this more than 10 times. Who does that? Not many nurses I've seen. But we should. We must. Some sins are greater than others with alcohol swabs. Being reckless with central lines is probably a greater (but most common) sin. Other times it's ridiculous. I've seen nurses skip the alcohol completely when they attach a piggyback line to a fluid line. Their reason? "It's an antibiotic."

As I said, nurse logic can be variously more and less unassailable. What is the takeaway lesson here? There are several. Don't reuse things that are not intended to be reused. Think about what you're doing and what you might be introducing into a patient's body. Remember that saving time and money by reusing things is false economy even if only one patient in your whole career becomes septic because you were in a hurry.