Help! IV not properly flushed..

  1. I have started as an extern and I notice the the RN was I working with does not bother to flush the line. There was at least half of the line still filled with air and he connected it to the pt anyway. I was in shocked cos this is against everything I've learnt in school.

    Can someone please clarify if this was correct/incorrect procedure?

    Thank you.
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  2. 16 Comments

  3. by   Hellllllo Nurse
    The nurse needs to flush the line, period.
  4. by   chris_at_lucas_RN
    Well you could always ask the nurse to "talk through" the flush, etc., the next time to help you "cement" what you are learning in school. It may be s/he doesn't know what's right, or just overlooked the flush. He/She may catch the error when they are teaching you....

    I can tell you from experience, even if your NM has encouraged you, the bright motivated student, to come to him/her with info like this because you are their eyes and ears, you should smile, nod, agree and then keep your mouth shut. No matter how delicately you put it, no matter how careful you are, you are "low man on the totem pole," and it will come back to nip your backside!

    If you feel you cannot tolerate watching poor care and errors, it may be time to look for a different unit or a different hospital, but I suspect that observing poor care and errors is a fact of life for nurses (which you already are, even as an extern).

    I saw a lot of stupid errors, some of which constituted abuse and criminal acts. I kept most of it to myself. Maybe I should have been more open about it--hard to know in retrospect. I just made the best decision I could with what I had at the time.

    For example, I saw a nurse grab a patient's arm and hold it hard against the siderail to get a blood sample the patient was loudly refusing (LOC was alert, oriented x3, etc., but she was a belligerant addict who didn't want to be there). Another cardiac patient repeatedly stated "I don't want you for my nurse, I am firing you" (something that particular nurse heard many times--and those were just the times I knew about!) and the nurse told the patient, "you have no choice until the next shift." How about giving IV push meds or drawing via a VAMP without swabbing the port? Going from bed to bed without washing hands? Leaving a patient to lie in their own excrement for the next shift to take care of?

    We can strive to be better nurses ourselves, when we are no longer students. Until then, make your mental notes about how it "should" be done, befriend a nurse whose skills you respect and learn from him/her. Be glad you have the smarts and caring to want to recognize and provide quality!

    Good luck.
  5. by   epiphany
    Thank you for you replies.

    Does anyone have first hand experience with the dangerous consequence of so much air going into the patient?
  6. by   traumaRUs
    Can't remember where I read this, but it actually takes 20cc of air into a peripheral line to cause an air embolus. (I'll look up a source to site when I get home tonight). For a central line it is much more important, but a few air bubbles in a peripheral line are no big deal. Did the pt get harmed?
  7. by   traumaRUs
    Okay - came up with this quickly:

    Air embolism
    The obstruction of a blood vessel (usually occurring in the lungs or heart) by air carried via the bloodstream



    WARNING: The minimum quantity of air that may be fatal to humans is not known. Animal experimentation indicates that fatal volumes of air are much larger than the quantity present in the entire length of IV tubing. Average IV tubing holds about 5 ml of air, an amount not ordinarily considered dangerous.
  8. by   Tweety
    They really make you paranoid of air in nursing school, and it's not all that necessary to worry about a little air. But half the line? It's so easy to finish priming a tubing when connecting. Flushing IV lines is important as well.

    This nurse probably isn't the best role model.

    We're not perfect, we all cut corners here and there, so don't nitpick every little detail, but this does sound sloppy.
  9. by   purplemania
    You will see lots of improper procedures performed by nurses, MDs, resp. therapy---just about anyone, because it comes down to how professional the individual practices. Do not let it affect YOUR practice. What you described was a lazy nurse. Be an example of professionalism.
  10. by   epiphany
    That's exactly what I needed to know. Can you give me the link to that info please?
  11. by   Groovydogg
    Hi Ephiph., While the airin the line was probably no problem, any air gap toward the internal end, it could (possibly) cause a coagulation. This is just a theory, but it is not silly. AND, to agree with every one else, it is VERY SLOPPY, and shows a lack of commitment. At the very least you should remember these quacks (does this term apply for nurses too??) every time you flush a line the right way.
  12. by   elkpark
    My dad is an anesthesiologist (MD), and I had a conversation with him about this long ago when I was a new nurse. He was highly amused that I was so concerned about air bubbles in IV tubing, and he said that the lumen of IV tubing is so narrow that the IV set only holds about 2-3 cc of fluid (or air) total. His comment to me at the time was, "You could run an entire IV set of air into the person's arm, and it wouldn't hurt them." After that, I was much less paranoid (that I was going to kill someone by overlooking a bubble in the tubing :chuckle ) but I have continued to be v. cautious about priming tubing for a different reason -- let's call it "aesthetics." Every "regular" person out on the street "KNOWS" (from watching TV!) that air in the IV line will kill them, and I try to remember what an awful feeling it would have to be to be lying there, helpless in a hospital bed, watching an air bubble chug slowly but resolutely down the tubing toward my arm if I believed that it would kill me when it got into my arm ...

    SO, the moral of the story is: A) What you are being taught in nursing school is good practice, and B) if you accidentally leave a little air in the tubing, you won't actually hurt the patient.
  13. by   critcarenurse16
    Quote from epiphany
    Thank you for you replies.

    Does anyone have first hand experience with the dangerous consequence of so much air going into the patient?
    When I was a graduate nurse my preceptor primed the tubing into the pt's IV. All the air (approx 15 ml) went to the pt. I was mortified she would do such a thing, and in front of a novice nurse. Fortunately no harm came to the pt. I asked for a new preceptor by the way.
  14. by   bobnurse
    You would be amazed on the amount of air a patient recieves or a period of weeks while on intravenous therapy. Its all about being lazy or poor practice....

    It cracks me up to see tv commercials on TV where nurses are giving IV pushes in the background with no gloves on or they dont even swipe the port with alcohol...

    We see it all the time with local commercials for hospitals. And it always seems to be done with peds patients...........

    Poor attention to detail.

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