# Can you safely draw saline from the IV tubing port?



## Beaux (Nov 13, 2011)

If you were to draw saline solution from a an IV line already in use, is there a high risk of contamination?  Would the fluid just come from the IV bag? Or could you potentially draw fluids back through the patient's IV?


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## Fish (Nov 13, 2011)

Beaux said:


> If you were to draw saline solution from a an IV line already in use, is there a high risk of contamination?  Would the fluid just come from the IV bag? Or could you potentially draw fluids back through the patient's IV?



It is safe


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## Beaux (Nov 13, 2011)

Fish said:


> It is safe



Thanks!

I witnessed this being done in a medic unit that for some reason, was not well stocked with flushes.  Saline was drawn up from an in-use IV tube (not the bag) on one patient, and then used to flush the line of another patient.

Seemed odd to me but you would know better than I, thanks again.


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## EMSrush (Nov 13, 2011)

While that sounds ok in theory, I'm not sure if I'd do that in practice.


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## silver (Nov 13, 2011)

Beaux said:


> Thanks!
> 
> I witnessed this being done in a medic unit that for some reason, was not well stocked with flushes.  Saline was drawn up from an in-use IV tube (not the bag) on one patient, and then used to flush the line of another patient.
> 
> Seemed odd to me but you would know better than I, thanks again.




Thats definitely an unconventional technique.


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## medicdan (Nov 13, 2011)

In theory, yes, but as others have said, I don't know anyone who would. 

What I have seen done, though, is drawing flushes out of bags not connected to a patient-- making a few flushes out of a 100cc bag, and using them over the course of the day (capping the syringes, of course). My sense is that they're not shelf stable outside of 12 or 24 hours, but can be used over a shift.


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## Handsome Robb (Nov 13, 2011)

Same patient, why not. Different patient I wouldn't. You can draw it right out of the bag even if it's hanging....I'd be more willing to do that rather than out of a med-port.


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## mikie (Nov 13, 2011)

Beaux said:


> Saline was drawn up from an in-use IV tube (not the bag) on one patient, and then used to flush the line of another patient.



Please tell me this was in a military or some sort of remote setting?


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## medicdan (Nov 13, 2011)

Beaux said:


> If you were to draw saline solution from a an IV line already in use, is there a high risk of contamination?  Would the fluid just come from the IV bag? Or could you potentially draw fluids back through the patient's IV?



If you're wondering this for use with patient care, I strongly encourage you to ask your service's administrators or supervisors for an official policy or statement... relying on the advice of a semi-anonymous internet forum is generally a bad idea when there's a chance things can go wrong...


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## Beaux (Nov 13, 2011)

mikie said:


> Please tell me this was in a military or some sort of remote setting?





emt.dan said:


> If you're wondering this for use with patient care, I strongly encourage you to ask your service's administrators or supervisors for an official policy or statement... relying on the advice of a semi-anonymous internet forum is generally a bad idea when there's a chance things can go wrong...



Thanks to everyone for the replies.

This occurred in a busy urban service, I was just a ride along on the call.  I don't know much about IVs/fluids as I'm not trained to use them.  I felt like what I saw was odd though, so I figured I would ask here.  I asked the medic who drew up the saline and he said that he wouldnt normally do this but was out of flushes.  

So outside of this being abnormal for a provider to do, is the second patient at risk for contracting something through this technique?  Most of you seem to think its safe...just the wrong thing to do.


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## Fish (Nov 13, 2011)

Flushes are preferred, I would never take saline from an IV bag of one patient and then use it on another, ever. Even if the risk Of blood being in the bag is super low. I am not taking that risk and would kill someone with a cross bow if they did that to me.


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## Akulahawk (Nov 13, 2011)

I would consider it unconventional, but generally safe. I would clamp below the port before drawing fluid though. Personally, I'd rather simply get another bag and draw from that bag instead of a currently flowing line that's going to another patient. Then I'd just label that new bag as IV flush solution as I'd have drawn the volume below the full level, potentially several times over.


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## bigbaldguy (Nov 13, 2011)

I'm not ALS but I've seen blood back up a good distance into a IV line. Even if the line appears clear there is still a potential that contamination is present. I can't see how this would be a good idea under any circumstances outside of absolute worst case scenario. Even if it is the same patient you could be introducing blood particles that have been in the IV line for several minutes back into the patient.


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## WTEngel (Nov 13, 2011)

While I do not think there is a high likelihood that this caused any harm to either patient, this is certainly not best practice.

I can almost certainly promise that if this happened in a hospital or any service I have ever worked for the person would have been written up at least, and very likely fired. 

What a sloppy, un-educated, haphazard way to operate.


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## Beaux (Nov 13, 2011)

bigbaldguy said:


> I'm not ALS but I've seen blood back up a good distance into a IV line. Even if the line appears clear there is still a potential that contamination is present. I can't see how this would be a good idea under any circumstances outside of absolute worst case scenario. Even if it is the same patient you could be introducing blood particles that have been in the IV line for several minutes back into the patient.



I know nothing about medicine, so forgive my ignorance and lack of proper termanology, but would it make a difference if the IV was connected to an IV lock instead of just directly to the catheter?

The medic had put a lock on the patient and connected the IV to that.  Does the lock prevent anything from getting backed up into the IV line?


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## bigbaldguy (Nov 13, 2011)

Beaux said:


> I know nothing about medicine, so forgive my ignorance and lack of proper termanology, but would it make a difference if the IV was connected to an IV lock instead of just directly to the catheter?
> 
> The medic had put a lock on the patient and connected the IV to that.  Does the lock prevent anything from getting backed up into the IV line?



Not with enough certainty that I would trust it no. I suspect the medic in this case was probably too lazy (or just forgot) to stock the truck with enough flushes and then was too lazy to go back and get them when they ran out.


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## WTEngel (Nov 13, 2011)

No, the leur lock tip only serves to keep fluid from leaking out when nothing is attached. Once the tubing is screwed into it, the lock is pushed open and remains open. It has no control over back flow. 

Can you imagine if for mass casualty events we had a large saline bag that attached to a single drip chamber with multiple primary tubing lines going to multiple patients? This is about as absurd as what the medic in question did. The more I think about this scenario the more I get irritated. It is things like this that make the rest of the health care community look at EMS like a vocation and not a profession. 

The worst part is that you witnessed it on a ride along, and were given the impression that it was ok. For all this guy knows you could go out and do this for the rest of your career...what an absolute disgrace.


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## Fish (Nov 14, 2011)

Cross bow I say!


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## Beaux (Nov 14, 2011)

I really appreciate all of the insight here guys and gals.  You are also freaking me the heck out!

What if this guy had some kind of infectious disease and now its been spread?  This is crazy and irresponsible.


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## usalsfyre (Nov 14, 2011)

Yeah, not in any way acceptable and frankly very lazy. A bags a buck fifty, so it's not about cost.


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## Beaux (Nov 14, 2011)

usalsfyre said:


> Yeah, not in any way acceptable and frankly very lazy. A bags a buck fifty, so it's not about cost.



So it would be safe to assume that the 2nd patient was exposed to the 1st patient's bodily fluids?  Yikes, i feel horrible for witnessing this.


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## Akulahawk (Nov 14, 2011)

WTEngel said:


> While I do not think there is a high likelihood that this caused any harm to either patient, this is certainly not best practice.
> 
> I can almost certainly promise that if this happened in a hospital or any service I have ever worked for the person would have been written up at least, and very likely fired.
> 
> *What a sloppy, un-educated, haphazard way to operate.*


That's putting it mildly, IMHO. Just to clarify an earlier point, while I did state that it's generally safe, I did NOT state that I condone the practice. I think that practice is one that should NEVER be done outside some seriously exigent circumstances. Normally, I would NEVER draw fluids from a line to flush _another _patient's line.


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## Akulahawk (Nov 14, 2011)

Beaux said:


> So it would be safe to assume that the 2nd patient was exposed to the 1st patient's bodily fluids?  Yikes, i feel horrible for witnessing this.


I wouldn't say the 2nd patient was exposed... just _potentially _(remotely so, but _still_) exposed to the 1st patient's blood.


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## mycrofft (Nov 14, 2011)

*Parse.*

It's wrong, they are single pt-use bags and tubing. No sophistry, it's wrong, and the pt stands to lose more than you do.


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## JPINFV (Nov 14, 2011)

Why aren't we simply pulling from the medication port on the IV bag instead of the actual IV tubing? Still not the best of ideas, but assuming that the drip chamber isn't completely full, then there should be next to no risk of cross contamination.


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## mycrofft (Nov 14, 2011)

*JPINV, risk ought to be zero above the drip.*

If you are running out of or don't have the little Saline vials, then you need to look to other shortfalls in your rig's stock as well, and your checkout procedure.


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## JPINFV (Nov 14, 2011)

^
I thought that went without saying...


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## MSDeltaFlt (Nov 14, 2011)

Tried to respond several times, but was on the highway through BFE in Mississippi. Yes some areas are more rural than others.  But, uh uh.  Completely unacceptable. Goes into cross contamination. You do NOT use one pt's IV bag to flush another pt's line.  Unconscionable.


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## exodus (Nov 14, 2011)

Our company does not supply flushes, we have to get them from the hospitals.


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## the_negro_puppy (Nov 14, 2011)

exodus said:


> Our company does not supply flushes, we have to get them from the hospitals.



Disgusting.


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## exodus (Nov 14, 2011)

the_negro_puppy said:


> Disgusting.



I've also been hearing they're going to stop supplying blood draw tubes as well. Even though certain protocols say to obtain blood if you have a line.


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## systemet (Nov 14, 2011)

WTEngel said:


> While I do not think there is a high likelihood that this caused any harm to either patient, this is certainly not best practice.
> 
> I can almost certainly promise that if this happened in a hospital or any service I have ever worked for the person would have been written up at least, and very likely fired.
> 
> What a sloppy, un-educated, haphazard way to operate.



This.  It's extremely hard to imagine a situation where it would be necessary to do this, and it smacks of being too lazy to open the cupboard / drug box and grab another source of saline.

I would have a frank and unpleasant discussion with anyone I saw or heard of doing this.


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## TomB (Nov 14, 2011)

I did it just a couple of weeks ago to draw up a 20 ml flush for adenosine. Our prefilled saline syringes are only 3 ml. I'm surprised by the harsh reaction. We used the appropriate aseptic technique. Throughout my career I've seen it many times in many settings (in and out of the hospital, ground transport, flight team). Is there a different procedure for drawing it out of a large vial? Or do you think connecting a syringe to an IV port is inherently unsafe?

Tom


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## usalsfyre (Nov 14, 2011)

TomB, I assume you were using it on the same patient though. The OP describes drawing off the line of patient one to flush patient two's IV.


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## MSDeltaFlt (Nov 14, 2011)

TomB said:


> I did it just a couple of weeks ago to draw up a 20 ml flush for adenosine. Our prefilled saline syringes are only 3 ml. I'm surprised by the harsh reaction. We used the appropriate aseptic technique. Throughout my career I've seen it many times in many settings (in and out of the hospital, ground transport, flight team). Is there a different procedure for drawing it out of a large vial? Or do you think connecting a syringe to an IV port is inherently unsafe?
> 
> Tom



Done that myself several times of drawing up a narc or a sedative in a 10cc syringe then draw saline from the bag to make it a 1:1 or 10:1.  However, that's for the same pt and the same pt only.


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## TomB (Nov 14, 2011)

usalsfyre said:


> TomB, I assume you were using it on the same patient though. The OP describes drawing off the line of patient one to flush patient two's IV.



Thanks for the clarification! That I would report as an unsafe practice.

Tom


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## Akulahawk (Nov 14, 2011)

TomB said:


> Thanks for the clarification! That I would report as an unsafe practice.
> 
> Tom


In the non-disaster situation presented by the OP... so would I. Under any sort of normal circumstances, even though the risk to the 2nd patient is low, I would NEVER do that and the risk, as low as it would be, is too high. 

I would MUCH rather draw from a second bag that's not connected to ANYTHING than draw from a line that's connected to another patient.


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## tssemt2010 (Nov 14, 2011)

guess he couldnt have just used a small saline bag to draw the stuff up with? id much rather crack open a new bag and draw it up from there than to draw it up from someone elses running line


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## julesdamedic (Nov 24, 2011)

WTEngel said:


> No, the leur lock tip only serves to keep fluid from leaking out when nothing is attached. Once the tubing is screwed into it, the lock is pushed open and remains open. It has no control over back flow.
> 
> Can you imagine if for mass casualty events we had a large saline bag that attached to a single drip chamber with multiple primary tubing lines going to multiple patients? This is about as absurd as what the medic in question did. The more I think about this scenario the more I get irritated. It is things like this that make the rest of the health care community look at EMS like a vocation and not a profession.
> 
> The worst part is that you witnessed it on a ride along, and were given the impression that it was ok. For all this guy knows you could go out and do this for the rest of your career...what an absolute disgrace.



Amen!


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## RocketMedic (Nov 27, 2011)

Beaux said:


> If you were to draw saline solution from a an IV line already in use, is there a high risk of contamination?  Would the fluid just come from the IV bag? Or could you potentially draw fluids back through the patient's IV?



No. The vein can be considered to terminate at the end of the IV, be it a saline lock or an IV bag. Since we don't run lines to atmosphere, an in-use line is the vein. I wouldn't mind using it to flush the SAME patient, but not another.


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## RocketMedic (Nov 27, 2011)

Amr?


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