Bonehead PICC/Midline flush question

IVRUS, BSN, RN · Jun 12, 2008

I know when administering meds thru a PICC/Midline the SASH method is employed. I know that when continuous IVF's are running into a PICC/Midline a 10cc saline flush is required BID, or q 12 hours.
What I don't know is...if there is a continuous IVF infusing into a PICC/Midline and a nurse has to give a IVP med, say MS, is SASH required? My thinking is that the PICC, single lumen, or Midline, is being kept open by the continuous IVF, so why should the nurse SASH, why not just give the med and flush it thru with a little saline and continue the IVF? And if SASH is required with continuous IVF's and say the PICC is single lumen, can the SASH be done thru the closest port to the patient or does the nurse have to disconect the primary line and directly SASH to the catheter port?, which does not seem like a good idea, risk of infection.
Sorry if this is so wordy and I hope it makes sense.
Thank you.

When you have continuous IVF infusing into a line, there is no need to flush the line at periodic intervals. However, when an IV Push medication is needed, once compatibility has been ascertained it IS okay to give it into the port closest to the patient and to remain connected while doing so. In the case of Morphine IVP, and you have a compatible mainline IVF infusing, the medication can be given after you do your 30 second scrub on the port you will be using to inject this medication. There is NO need to flush with saline beforehand as they are compatible, right? Now, if they aren't compatible, then clamp the mainline and flush with saline, give the medication over the appropriate time frame, and then flush with saline again and restart the mainline. Disconnecting and reconnecting DOES increase the infection potential.

Hope it helps

DD

accessqueen · Jun 12, 2008

If you have a continuous infusion you do not have to flush the line every 12 hours. Every manipulation of hubs increases potential for infection. If you have iv fluids running and you need to do a push, you do not need to use SASH, the H is for heparin, there is no point in heparinizing a line that is running. There are times, though, when you may need to clear the line with saline before and after a push, i.e. Dilantin. Dilantin cannot be mixed with dextrose at all or it will precipitate. If you have a D5 1/2 running you would have to clear the line with saline before and after a push. You can push through any port.

garciadiego · Jun 12, 2008

Thank you IVRUS for your reply, you have answered my question almost entirely.

The only lingering doubt that remains is this..... let's say the nurse has established compatibility of the fluid with the MS and gives the MS IVP.....what then? Does the nurse simply re-start the IVF's? or does the nurse have to flush with saline and heparin after giving the MS push and then re start the IVF?

Unrelated to the question but related to the topic of PICC/Midline use....these lines are very time consuming to use....all this flushing with saline and heparin....Just an observation.

Thanks.

IVRUS, BSN, RN · Jun 12, 2008

Thank you IVRUS for your reply, you have answered my question almost entirely.
The only lingering doubt that remains is this..... let's say the nurse has established compatibility of the fluid with the MS and gives the MS IVP.....what then? Does the nurse simply re-start the IVF's? or does the nurse have to flush with saline and heparin after giving the MS push and then re start the IVF?
Unrelated to the question but related to the topic of PICC/Midline use....these lines are very time consuming to use....all this flushing with saline and heparin....Just an observation.
Thanks.

After giving the MSO4, then simply restart the mainline infusion (if it's been shut off). Many will just give the medication over the approriate time frame and then release the slide clamp, or stop "pinching" the IV tubing and you're good to go.

Any line (a short term peripheral, a midline, a PICC, or a MD placed CVAD) requires line maintenance and appropriate flushing as needed to maintain patency, however, think of the benefits of a catheter like a PICC: long term use (A PICC line can stay in for years in the absence of complications); all types of medication can be given through them as they are centrally placed; the cost of a PICC expanded over several weeks or even months is a real bargain in every aspect of the word; with proper maintenance and care, it prevents your pt from repeated venipunctures and the pain associated with them.

The key is to develop a greater knowledge base so that you have a greater comfort level when providing maintenance and care, which will in turn benefit your patient immensely.

iluvivt, BSN, RN · Jun 13, 2008

Just remember that if your primary line is going faster than the safe administration rate for the IV push you should use the saline at the desired rate and then resume your IVF. Also when hanging a new TPN and or Lipids you should flush with the NS b/c the lipids tend to build up and make that lumen sluggish. This is true for all CVCs. Agree with above nurse....PICC is for the patient...to give medications and therapies in a timely manner...reduce all the risks of peripheral IVT...promotes venous preservation. Have you seen a patient getting peripheral antiobiotics for a week or so. There arms are chewed up. PICCs are great with a low infection rate and all lines need flushing and maintenance.

garciadiego · Jun 13, 2008

Thank you all for your insights, and thank you if there all any further replies.

giveandtake · Jul 17, 2008

A more simple way to think about SASH is that the whole purpose of placing heparin in the line is so that the heparin sits inside of the line and keeps it open. If you will be starting IV fluids back up immediately then the heparin will just get pushed into the patient. Also, the IV fluids you are running will be keeping the line open, so you don't need heparin to do this for you.

:twocents: