Nursing practice often involves undertaking procedures about which there is debate or uncertainty. In Practice Question we ask experts to determine how nurses should approach these situations
Q. Is it true that best practice for administering IV flushes/boluses is via a Luer lock syringe as opposed to a Luer slip?
A: It depends on the medication given, the route and the method used to administer the injection.
What are Luer slip and Luer lock syringes?
Syringes are classified as being Luer lock or non Luer lock. The latter is also referred to as Luer slip.
A Luer lock syringe enables a needle to be twisted onto the tip and be locked into place, providing a secure connection and preventing accidental removal of the needle as well as accidental injection of contents (Elkin et al, 2004).
A Luer slip syringe allows the needle to be pushed on to the tip if a needle is required – some, such as oral or bladder syringes, have Luer slip tips but do not accept a needle.
The placement of the tip can be:
- Eccentric, which allows the practitioner to get close to the skin;
- Concentric, which is used for all other applications (Fig 1).
Luer slip syringes are cheaper than Luer lock syringes.
In most general text books on preparing medications in syringes for subcutaneous, intramuscular or intravenous injection, the type of syringe to be used is not described.
What is best practice?
Luer slip syringes are used for IM and subcutaneous injections.
Luer lock syringe are recommended in certain circumstances for IV therapy. These include attaching a syringe to a syringe pump, to prevent disconnection (Medicines and Healthcare products Regulatory Agency, 2003) or when preparing and administering cytotoxic drugs to prevent disconnection and spillage or splashing of drugs (Bravery, 2008; Gabriel, 2008).
During administration via a central venous access device, it may be necessary to use a Luer lock syringe to prevent disconnection, blood spillage and/or air entry if a closed system is not being used (Dougherty, 2008).
However, concerning the administration of IV bolus injections or flushes, there are no clear recommendations.
Most trusts use needle free systems, and both Luer slip and Luer lock syringes connect securely to needle free injection caps. Luer lock syringes can be twisted on to provide a secure connection, while Luer slips are pushed into the cap and, once given a quarter turn, will also provide a secure connection. Care must be taken not to turn the Luer slip tip too far or it will pop out of the cap, resulting in disconnection.
When administration sets with needle free connections at the Y site or side arm are used, bolus injections can be given without a needle using either syringe type.
Either type of syringe can be used to administer an IV bolus injection or flush. The key consideration is the solution being administered – bolus IV antibiotics can be administered via a Luer slip syringe but cytotoxic drugs must be administered via a Luer lock syringe (Polovich et al, 2009).
If a practitioner is going to remain with the patient, a Luer slip syringe is appropriate but, if the patient is to be left to receive an infusion – for example via a syringe pump – then a Luer lock syringe must be used. l
AUTHOR Lisa Dougherty OBE, DClinPrac, MSc, RN, is nurse consultant, intravenous therapy, at the Royal Marsden Foundation Trust, London and Surrey
Bravery, K. (2008) Paediatric intravenous therapy in practice. In: Dougherty, L., Lamb, J. (eds) Intravenous Therapy in Nursing Practice. Oxford: Blackwell Publishing.
Dougherty, L. (2008) Vascular access devices. In: Dougherty, L., Lister, S. (eds) The Royal Marsden Manual of Clinical Nursing Procedures. Oxford: Wiley Blackwell.
Elkin, M.K. et al (2004) Nursing Interventions and Clinical Skills. St Louis, MO: Mosby.
Gabriel, J. (2008) Safe handling and administration of IV cytotoxic drugs. In: Dougherty, L., Lamb, J. (eds) IntravenousTherapy in Nursing Practice. Oxford: Blackwell Publishing.
MHRA (2003) Infusion Systems: Bulletin DB 2003 (02). London: MHRA.
Polovich, M. et al (2009) Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Pittsburgh, PA: ONS Publishing.