Dilemma situation! I'm not a nurse, but is this common practice??

[Nursing617]

Resident had an iv catheter to have morphine administered subcutaneously via a butterfly needle on the abdomen. Before the nurse administered the morphine, he mentioned out loud that he had to get the heparin first (referring to the flush). I then witnessed the nurse flush the iv butterfly with the heparin, then the morphine, followed by the heparin flush.

[bananas1]

Not nasty at all... just direct.

You have the freedom to respond how you'd like; extend to others the same.

You have the freedom to talk to patients and clients how you'd like to, but you don't because it's discourteous

[ontnursec]

Subcutaneous butterflys are commonly used in community where I work. We do not flush them. The subcut tissue cannot accommodate that much fluid. The line is primed with the medication not saline. Heparin before and after is very strange. Bribg it up to your manager, as you may have misunderstood what the nurse was doing. He may have given a heparin injection and given subcut med through the butterfly separately

[NurseCard, ADN]

I find this thread quite fascinating; I have NEVER seen a subQ "site" in all of my

years of nursing. Learn something new every day!

Now I know there is an option for our little old people who have no veins but

still need certain IV drugs. Then again there is still SL morpine.

[ontnursec]

I find this thread quite fascinating; I have NEVER seen a subQ "site" in all of my

years of nursing. Learn something new every day!

Now I know there is an option for our little old people who have no veins but

still need certain IV drugs. Then again there is still SL morpine.

I mainly see them in palliative care at end of life when oral access is lost. Mainly for Subcut hydromorphone, dexamethasone, and haldol.

[mburkhar]

Late add on to this but in my 40 years or so I have yet to see the need to prevent clots with a SQ catheter (which is used all the time in settings where staff are not permitted to give IVP meds). SQ is a bona fide route for many drugs and it is also kinder gentler sometimes than IV infusions. A number of drugs now have drug delivery devices (Neulasta for example) that infuse SQ intermittently or continuously (V-Go devices). Heparin following morphine SQ seems pretty odd indeed. I would ask for the policy on SQ drug administration and if there isn't one there should be to protect you and the patients.

[psu_213, BSN, RN]

This is actually quite common in the ECF/home setting. A small gauge butterfly is inserted SQ and a Tegaderm placed over it.

Would the nurse even flush if it were intended to be SQ? I've never done it, so I'm curious.

[Wuzzie]

Would the nurse even flush if it were intended to be SQ? I've never done it, so I'm curious.

Generally no, it is primed with the medication so no flush is needed.

[Tenebrae, BSN, RN]

My role is a concerned employee. Need I say more? And he's been a nurse for a couple of years. If this was your loved one and something didn't seem right, you would be concerned too. It was Heparin

Did you see the nurse draw up the flush from heparin ampoule or prefilled heparin syringe?

[Tenebrae, BSN, RN]

Would the nurse even flush if it were intended to be SQ? I've never done it, so I'm curious.

We use these

[ATTACH=CONFIG]27460[/ATTACH]

If the line doesnt have a syringe pump running through it, then I will 'flush' that is, insert about 0.5-1ml sterile water after administering a medication, to ensure that the medication gets into the body and doesnt stay in the line

But, no, I wouldnt use anything but sterile water or normal saline, because often the patient is quite cachexic and while the lines can stay in for up to 10 days, often they may not last any longer than a couple of days and I want to protect the patient's tissues as much as possible

[Decitabinequeen]

We use these

[ATTACH=CONFIG]27460[/ATTACH]

If the line doesnt have a syringe pump running through it, then I will 'flush' that is, insert about 0.5-1ml sterile water after administering a medication, to ensure that the medication gets into the body and doesnt stay in the line

But, no, I wouldnt use anything but sterile water or normal saline, because often the patient is quite cachexic and while the lines can stay in for up to 10 days, often they may not last any longer than a couple of days and I want to protect the patient's tissues as much as possible

I haven't seen this type of IV catheter since leaving ophthalmology! Thanks for the flashback!