Hi
I'm interested to hear if anyone uses the same 50ml syringe for the same patient when using TIVA. In our trust we use a new syringe for each 50ml of propofol and also a new 50ml syringe for remifentanil. It seems unnecessary to me. I know there is an issue with the syringe 'sticking' but I believe that doesn't happen until 3 or more uses. Thoughts please?
Thanks,
Louise
We currently discourage this at RCHT partly because of "Stiction" that you have mentioned and also because of concerns regarding infection / contamination, particularly with propofol. What we have been encouraging is for clinicians to try and calculate how much propofol they are likely to need for each syringe change - particularly when running sedation, and to use a 20 ml rather than waste 50 mls if appropriate.
I think you would struggle to sell this idea to most Trusts. I do use the same 2 50ml syringes on each patient though.
Locally we are trying to encourage this amonst anaesthetists, but have to accept that everyone is an indervidual!
Today i am doing a 12-18 hour max fax cancer free flap op. I plan to use 4 50ml syringes, but have to keep an eye on ODPs. I have never had an issue with sticky syringes. Keep two spare syringes connected to spike or bunged off when not being used.
will let you know when got department SOP in place....
It would be good to start applying the Royal Pharmaceutical Society Safe and Secure Handling of Medicines (December 2018) recommendations.
Appendix C: Operating theatres – C1 As outlined in the core guidance, manipulation of medicines in clinical areas is minimised and medicines are presented as prefilled syringes or other ‘ready-to-administer’ preparations wherever possible.
Using 50ml prefilled syringes of Propofol, Noradrenaline, Insulin for infusions at a stroke reduces the amount of stuff used, ampoules, packaging, needles and their separate transport to the hospital etc as well as having many other advantages of safety, sterility with their accompanying additional environmental benefits. https://www.fiercepharma.com/manufacturing/teva-partners-fined-20m-second-propofol-hep-c-case
Best to recycle rather than reuse 50ml syringes. In Netherlands they used to take the glass 50ml Prefilled Propofol syringes apart and recycle the glass barrel and rubber plunger. Maybe all plastic syringes could be made of recyclable material.
Thank you, yes please do let me know when you have your SOP!
Hi Louise
Ive moved to TIVA and do re-use with no sticking issues. I spike each empty one straight into the propofol bottle and refill to avoid leaving it hanging around while i use my next full syringe. It keeps me going for my free flaps where the alternative of using a new one every time is unimaginable. Agree that towards the end of a case in order to avoid waste of propofol using 20ml works well
We are in the process of auditing our propofol waste as I agree that we should be using the most appropriate volume/syringe depending on the procedure and operating time left