Saline flush without a physician order?

[stephenfnielsen]

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?

[nightengalegoddess]

Stephenneilsen..OPer.........you speak and question ALOT like an attorney or judge. Are you really a nurse? Or are you fishing here because you or someone else has gotten in some kind of trouble for flushing a line with saline? In that case, if someone got in trouble for that somehow.....I wonder if it was another type of line they messed with without an order. Hum. Just wonderin'......got nothing against legal people......it just seems odd about how this topic is being picked apart when it is really quite simple.

Just as if an RN saw a wound dressing that is saturated with blood when it should not be.....she would either change the dressing, assess this wound if the surgeon has already examined it......or she would reinforce......or put a sandbag on it if necessary.........and she would call the doc to notify. Whether or not that wound has dressing orders....it is reasonable that the RN would adress it somehow even if she doesn't have time to scour the chart for an order......she will act and then usually solidify the order with the doc. I love when you come in and the wound dressing has a five day old date and seen that no one has charted on what's under there......and some nurse says...."Oh, there's no order.....so I didn't touch it."...(that may be normal first day post op to leave dressing alone for surgeon to do original assessment)......but it seems like negligence to not seek an order for five days....(while necrosis is brewing under that old dressing).....etc etc..........

So in other words......follow the hospital policy......if ya need to flush.......get the order!!!!! I would think it negligent not to flush a periph. q 8 even if the doc said...."don't flush that with saline!!!"........(when the patient gets Phlebitis or something)........ya make sure it is well charted you sought that flush order and the doc said no. Once two RNs a day call the doc for the flush order perhaps he will get a clue. And hopefully, one of those RN's had a brain and just flushed the darn thing with saline anyway (unless the pt is allergic?).....knowing that it would cause MORE HARM NOT TO.

So the op'r is using saline flush as a metaphore? Because obviously, giving narcs without an order even if the patient requires it for pain control is something capable of causing A LOT of harm.......flushing a periph with saline could cause very little harm. Sometimes nurses have to take action without an order if it will cause harm not to at the time and it is a reasonable action that most nurses would also do in the same situation. Best idea.....know the policies.....get the orders!!!!!!!!!!!!!!!!!!

[Esme12, ASN, BSN, RN]

Let's say the institution has a policy that the IV is to be flushed q8hr, but there isn't an order for the patient... I like the idea of doing it "per protocol", but remember, nurses can't initiate protocols, a physician must do that. For example, just because an institution has an insulin drip protocol, it can't be acted upon by a nurse until a physician initiates it.

The order is contained within the order to start the IV heploc. The MD orders the heploc/saline loc which begins the path of standards of care/policy and procedure which states the care of said heploc including that the heploc/saline loc will be flushed with 3 cc saline every X hours to keep patent. Which is a nursing measure as standard of care and saline in this senario is not considered a med becasue it's intention is not to treat or diagnose a patient and therefore needs no order.:)

[wooh, BSN, RN]

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

Having fun tonight?

The 10cc syringes do work well for babies though.

[MunoRN, RN]

You don't need an order for saline flushes because saline flushes are not a drug. It may differ in some states, but my state's DOH uses the FDA definition of a "drug" in determining what requires an MD order. The FDA definition is:

"The FD&C Act defines drugs, in part, by their intended use, as "articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease" and "articles (other than food) intended to affect the structure or any function of the body of man or other animals" [FD&C Act, sec. 201(g)(1)]."

Saline flushes fall under device maintenance, and are not intended to diagnose, cure, affect the structure of or...etc. We don't get orders for flushes, nor do we have standing orders or protocols that allow nurses to use saline flushes and our world hasn't come crashing down.

[eman6]

i think its part of the nursing care of the line without order to me in PICU its consider as care of line, you have to follow your protocol line care

[wooh, BSN, RN]

I'll repeat myself, you can't flush an IV without some kind of a physician order... or am I wrong. If a facility is doing so without a standing order in place, they are ripe for penalty!

Ripe for penalty? RN flushes line with saline. IV stays open. Hmmmmm.... Where's the lawsuit here? If you want to make a big deal about it, then get the standard IV order for your facility changed to "insert and maintain." Otherwise, you're just arguing for the sake of arguing.

You're 27 according to your profile? So you had a couple years at most bedside, and now you want to tell the people that have been doing it for years how to do their job? And apparently make more hoops for the bedside nurses to jump through to be able to do their job? I see a bright future for you working for Joint Commission!!

[Flo., BSN, RN]

I also clean the cap with an alcohol swab before I give the saline. Should I get an order for that?

I will follow your lead and answer my own question. No because it is the standard of care. When a pt has a PIV I flush it. When I access a line I scrub the hub.

[Katie5]

Let's say the institution has a policy that the IV is to be flushed q8hr, but there isn't an order for the patient... I like the idea of doing it "per protocol", but remember, nurses can't initiate protocols, a physician must do that. For example, just because an institution has an insulin drip protocol, it can't be acted upon by a nurse until a physician initiates it.

Perhaps I am wrong, but I thought a protocol was a standing order in which to initiate a certain course of action when requirements were met.

[SharonH, RN]

You don't need an order for saline flushes because saline flushes are not a drug. It may differ in some states, but my state's DOH uses the FDA definition of a "drug" in determining what requires an MD order. The FDA definition is:

"The FD&C Act defines drugs, in part, by their intended use, as "articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease" and "articles (other than food) intended to affect the structure or any function of the body of man or other animals" [FD&C Act, sec. 201(g)(1)]."

Saline flushes fall under device maintenance, and are not intended to diagnose, cure, affect the structure of or...etc. We don't get orders for flushes, nor do we have standing orders or protocols that allow nurses to use saline flushes and our world hasn't come crashing down.

Thank you! A physician order to flush an INT, good grief, never heard of such a thing.

[retiredlady]

Poster, when you get the order for a saline lock that includes the saline. The floor or hospital has the protocol for how often to flush and PRN as needed to maintain it or we use too. Sometimes Drs order it for like every 4 hours or so esp on the cardiac floors if it is a central line. It is not a drug. Try calling the doctor late at night for an order for saline flushes for a saline lock that is already in and i bet you will only do it once. Esp if you wake him or her up. lol.

[BrandonB779]

At our hospitals policy, anytime an order for fluids or IVs are started there is an automatic policy for flushes Q8 hours in our medication administration record so that we can keep veins patent in comparison to KVO IVs at 5 mL/hour.

[rn/writer, RN]

I'm thinking the OP is not a nurse. Might be a baby doc looking to flex his muscles and 'splain it to us uppity nurses. Clearly confoozled on the concept of facility policies and line maintenance obligations.