Saline flush without a physician order?

Nurses General Nursing

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Let's say a patient has a saline locked IV. The nurse knows that it is best practice to flush saline locked IVs with saline every 8 hours. Can she do this without a physician order?

Specializes in geriatrics.

With all IVs, you are expected to maintain the integrity of the line. You use your judgment according to how often the line is flushed, keeping in mind hospital policies. An order for a saline flush is not required. Same with O2 where I work. If we need to give O2 to maintain vitals we do so, no order required.

Specializes in ICU, Informatics.
With all IVs, you are expected to maintain the integrity of the line. You use your judgment according to how often the line is flushed, keeping in mind hospital policies. An order for a saline flush is not required. Same with O2 where I work. If we need to give O2 to maintain vitals we do so, no order required.

I think the centers for medicare and medicaid would take issue with a nurse administering O2 without an order. Let's be real, yes, give your patient O2 if the sats are tanking, but you then would need to call the MD to get an order (for billing purposes).

Specializes in geriatrics.

First of all, I am well aware what my scope of practice is, in addition to my facility's policies. Secondly, I am a Canadian nurse, and we don't bill for everything. More importantly, as others have already pointed out, for some reason, you seem intent on making assumptions about other nurses and being antagonistic. I'm not sure why....

Specializes in ICU, Informatics.
First of all, I am well aware what my scope of practice is, in addition to my facility's policies. Secondly, I am a Canadian nurse, and we don't bill for everything. More importantly, as others have already pointed out, for some reason, you seem intent on making assumptions about other nurses and being antagonistic. I'm not sure why....

Yes, I did make the assumption that you practiced in the US, and I was wrong, I apologize.

Specializes in Emergency Dept. Trauma. Pediatrics.

i don't see how we bill for a flush, it's never scanned or accounted for when used for a patient. so the patient isn't billed for it. (at my facility) bags are, flushes are not. i have never seen an order at my current facility for a flush. i know there is a policy that an iv with a buff cap needs to be flushed a minimum of once per shift.

i just looked at the bon for my state regarding this but it doesn't seem very clear cut to me.

as far as not thinking before doing things, i do think before doing something, i think "if i don't flush before and after this medication i might put medication into a vein no longer viable and/or not all the medication might get to the patient. a small bit might linger in the port" or "if i don't flush this line it might allow it to clot off."

this is what i found on my states bon

[color=#002b51]scope of practice for the registered nurse (rn)

in colorado, the practice of professional nursing (including those listed on the advanced practice registry) includes the performance of both independent nursing functions and delegated medical functions. the board of nursing (bon) considers rns to be independent practitioners.

two things limit the independent scope of nursing practice:


  1. task/practice must be within the field of nursing, and

  2. rn must possess the specialized knowledge, judgment and skill required to complete the job/task undertaken. there is no bon requirement for physician oversight of nurses during the course of independent nursing practice. however, individual facilities or physician practices may have policies requiring some level of physician involvement or oversight.

dependent nursing function falls under delegated medical. crs 12-38-103 (4) defines delegated medical function to include the rn implementation of a medical plan. ".a written plan, verbal order, standing order, or protocol - whether patient specific or not, that authorizesspecific or discretionarymedical action, which may include but is not limited to the selection of medication." the amount of physician oversight would be determined by the physician and nurse involved in this process.

Specializes in Med/Surg/Tele/Onc.

At my facility, there were order sets that could be initiated by a nurse such as skin care, IV orders, and specific order sets for specific floors. Doctors did not have to write "initiate such and such.....". Nurses were allowed to do that. As a matter of fact, we could get in trouble if we DIDN'T initiate some, like skin care. There were other order sets a dr did have to initiate, such as insulin SS and heparin.

And Loca showed that it is within our scope.

Specializes in Critical Care.

At my hospital the saline flushes are POLICY, so no order is needed. And the flushes are not scanned either.

For any type of central access (including implanted ports) or PICCS, the order set for insertion includes the order on how to maintain, heparin vs. saline and frequency plus prn. Only heparin flushes get scanned.

Specializes in Oncology; medical specialty website.
Umm... well a number of people feel that they can do said activity without an order, which I think we would both disagree with, so I feel justified in raising the question.

What was the point of posing this question? You've already decided that you are right and everyone else is wrong. Worry more about your own practice and less about what other people are doing.

Specializes in Oncology; medical specialty website.
I think the centers for medicare and medicaid would take issue with a nurse administering O2 without an order. Let's be real, yes, give your patient O2 if the sats are tanking, but you then would need to call the MD to get an order (for billing purposes).

You've obviously never worked in the ED. I can just imagine what would happen in a pt. suddenly started to desat, and rather than putting O2 in the pt. to avoid a crisis, you'd go traipsing after the doctor to ask for an order first. "Uhm, my patient is blue, but I didn't want to start O2 without an order from you first, Doctor."

A bolus isn't generally ordered via 3-5 cc syringe....maybe for a gerbil... :eek:

Having fun tonight?

:lol2:

Specializes in PICU, ICU, Hospice, Mgmt, DON.

Yeah, I didn't mind the fact that the boluses were in 5cc syringes, it just took so DARN long to get 500cc in.....you mean I could have given it some other way???????? Now you tell me!!!!

Specializes in tele, oncology.

If a protocol exists at the facility (not order set, not standing orders, but a protocol), the nurse may initiate the orders "per protocol" and they do not require a physician sign off.

Line maintenance, fall precautions, certain aspects of skin/wound care, swabbing for MRSA/VRE, and sending a UA/cx off with new Foley placement are the ones that come to mind that I come across most frequently off the top of my head.

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