Administering flush after a small volume med.

[haiku]

I have seen many times experienced NICU nurses administering a flush very quickly after giving a small volume med. For example, if they have a med that is less than the 0.4 volume microbore tubing, they will just push it into the microbore, then set 1.5cc of flush over 30 minutes; or will infuse a 0.9cc volume of med over 30 minutes, then follow that with a 1.5cc flush set up on a pump to infuse over 10 minutes. The first scenario results in the medication being given at 3cc/hr instead of 0.8cc/hr, and the second scenario results in the med being infused at 9cc/hr instead of 1.8cc/hr.

The meds come up in the small volumes unit dosed from pharmacy. Can you tell me what the policy is at your facility as far as making sure that the medication in the tubing is actually administered at the correct rate? I've suggested that those small volume drugs be diluted out to at least 1 cc then we can give all of the flushes at 2cc/hr. How does your unit handle this problem?

[twinkletoes53]

We have a Pharmacy "Black Book" in our unit, with the recommended dilutions for each drug we give, and over how long it should be given. This Helpful book was put together by one of our RNs with a Master's degree.

I always run the medication and the flush at exactly the same rate. My "total volume" to be infused would be the amount of medication + 0.7 mls. flush, which is the volume of the Microbore tubing + whatever extension set is attached to it. So if I'm giving 5 mls. over 30 minutes, my rate would be 10 mls/hr; whether I'm infusing the medication or the flush that follows it.

[haiku]

Thanks for the reply, but let me clarify my understanding of what you are saying,

If your med volume is 0.2ml, and your flush volume ( for the tubings ) is 1ml, then you would say that your "total volume" is 1.2ml?

If I am understanding correctly then your set rate would be 2.4ml/hr?

If this is true then the medication is actually going in over the first 5 minutes instead of 30, and the flush behind it is going in over the next 25 minutes. The set rate for either the med or the flush would have to be be set at 0.4ml/hr to actually deliver the med over 30 minutes.

In the scenario you gave, I'm getting that your med volume is 4.3ml and your flush volume is 0.7 ml, so your should be set at 8.6ml/hr to deliver the med over 30 minutes. If you are setting the pump at 10ml/hr the med is being given over 25 minutes, not 30.

I know this isn't much of a difference, but as the med volume goes down, the ratio of med volume to flush volume changes and the rate of actual med infusion goes up significantly as seen in the scenario I presented.

Please correct me if I am misunderstanding. But this is exactly the med error that I see a lot.

Please reply.

Thank You :)

[BabyLady, BSN, RN]

To me, it all boils down to nurses that aren't reading the Neofax and not making good judgments...it's not rocket science.

You have to consider, that the med still remaining before you flush needs to be flushed at the same rate as the med was given.

To me, that is medication administration 101.

It should be treated as a med error and the management needs to step in and address it.

[littleneoRN]

We dilute small volume meds to 0.8 ml, the volume of our microbore medline tubing. The med is then hand flushed into the line, followed by a flush over the amount of time recommended for infusing the medication.