IV precipitation

Specialties Infusion

Published

Please tell me what I did wrong. Patient was on levaquin IV. Doctor prescribed a now order for Lasix IV push. So, I stopped the levaquin, ran the Saline line at 100 for 25-30. Then I proceeded to push the lasix. I drewback and the syringe looked a little cloudy - but, because I never saw a med precipitate (I thought it crystalized immediately). I made a stupid, stupid judgement and thought it was ok. I started to push it but then second guessed myself and stopped. I turned off the pump immediately and took the line off the patient. Only then did I see the crystalization. Can you please tell me what I actually did wrong? Did I need to flush it longer or should I have gotten a new saline bag and pushed it through a new line. Luckily, the IV therapist was in the next room so, I had her look at patient's iv site, she was able to flush 10cc. I am really upset about this - I keep thinking what if i would have continued to push the lasix. What would happen? Also, I worry that some of the contaminated fluid entered the patient. Most likely not, but, would the IV flush if the precipitated fluid went into the vein? I am a new nurse, but it doesn't excuse my mistake. thanks for your response.

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Specializes in LTC.

I don't know anything about IVs, but did you ask the IV therapist about it?

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Specializes in Anesthesia.

A lot of times especially with the new needless systems a small amount of medicine is retained in the injection ports. What I have started doing to help prevent this problem is to take a 10cc syringe and flushing the port I intend on using with a more forceful flush than can be provided by just the IV bag.

Hope this helps.....

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I think that flushing with the syringe sanwich method is best, as was just said. Saline-med-saline, even though you saline flushed from a bag. The syringe flush gives a more turbulant flush as well as cleaning out the port. Sometimes, if meds are very incompatible (eg Dilantin ) we'll suggest a seperate IV line, then you can unhook and hook-up again at the extension site close to the pt. I think you did well to realize you had a problem right away.

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Not sure what happened in this case, but I have seen precipitate in an IV line. I was a new RN on a med-surg floor. I think I was giving Dilantin IV push and the line instantly turned a crystal white from the injection port on down. I immediately shut off the IV infusion and ended up re-starting the IV in his other arm.

This is a similar situation. You know how we're supposed to pull back in the syringe when giving an IM injection to check for the rare instance that you've hit a vein? I had that happen to me, coincidently in the same year at the same job. Was giving a post-op patient some Demeral and the syringe instantly turned red! I pulled the needle out without giving the drug and got her another syringe. Pretty freaky!

Cindy

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Specializes in Emergency, House Supervision, IV Therapy.

You cannot flush a line effectively with the running of the fluid with the pump, you have to use a syringe and use a turbulent, push/pause method to get the swirling motion within the line and catheter to clear anything out of the catheter. Sorry, I know that can be scary. I never recommend anyone to use an infusion pump to "flush" with.

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There are many, many medications out there that are incompatible with other meds, even Heparin. It is best practice to always flush with Saline first before giving any med, and then again afterwards followed by Heparin (if this is your policy). This will hopefully prevent any crystalization/precipitation from forming and also check patency of the line before giving a potentially dangerous drug that could cause severe extravasation.

Donna

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I'm a soon-to-be nursing grad (May 2nd) and I just wanted to say thank you to the responders of this thread. It saved my tush the other day on the clinical floor!

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Specializes in Infusion Nursing, Home Health Infusion.

If your medications are incompatable you need to give the medication at the t extension or in other words directly at the site. Put the IV pump on hold or off,then flush with Normal Saline I use at least 5 ml preservative free, using a turbulent flush then give the lasix dose then follow with the NS again. Then resume your IV, Some medications with extreme ph differences (such as bicarb and dilantin) can be very challenging. I often just start a second site

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