When your child has (or you have) a central line catheter like a port-a-cath, sterile procedure is never something you take lightly.
But we as parents generally haven’t gone to nursing school. We aren’t trained and tested in aseptic techniques and sterile fields.
But we are the ones most determined to keep our children safe. As it should be.
So we learn. And we pay attention. And often, we catch things that even the experts don’t catch.
Such an event occurred a few months ago.
And if I didn’t do Case’s infusions myself, it’s entirely possible I wouldn’t have known enough to catch it. And that’s all it takes to get a port infection, or a blood infection, or another serious complication.
On to the nitty gritty….
Did you know there are two types of saline syringes? A sterile syringe and a non-sterile syringe.
But, the saline HAS to be sterile, you say. Well, yes, the saline inside the syringe is always sterile. As is the syringe tip, underneath the cap.
But the outside of the syringe is not sterile unless the packaging says so. And it clearly says to not place it on a sterile field as you can see from the picture above. What does that mean?
The outside is not sterile.
So when you touch it with your sterile gloved hand, to connect it to the clave or the needle, or to prime it or access, your hand is no longer sterile either. And when you place it on the sterile field and it rolls into the needle … well, then your needle’s not sterile, and you’re getting ready to stick that needle into your child’s chest (FYI: don’t ever remove the needle cover until right before use anyway). Yeah, that wasn’t a fun moment to watch.
That is what makes this syringe particularly troublesome in the case of a central line access.
So why would this syringe ever be sent for infusions via port-a-cath?
Reason: The fully sterile syringe was on shortage for a period of time.
I only know this because I’m one of the FDA nerds who reads the FDA’s regular updates of drugs and supplies that go on shortage. Genzyme’s Fabrazyme shortage was not lost on me.
But my understanding is that the supply has stabilized and these are now available again.
(Pssst… I have a delivery coming this week.)
The handling of sterile syringes are just one aspect of aseptic technique where things can go wrong. The two others where I’ve witnessed errors by professionals include (1) not performing a full 30 second friction rub of the access area with chlorhexidine (or other sterilizing agent) with complete air dry thereafter (note: if it’s not completely dry, it can also sting during access when the chlorhexidine enters the skin break), and (2) not scrubbing the top and sides of the access hub for a full 10-15 seconds, also with air dry. Short times, coverage area, and hand waving to dry are particular problems I’ve seen.
Be aware of the type of syringe being used. Be aware of where things are placed. Be aware of sterile scrubbing and drying. Be aware of aseptic technique.