There is a huge blowup at my hospital lately about the practice of priming an antibiotic line with normal saline first.
The nature of our EMR system automatically names some things - like Zosyn, Iron, and K-riders - piggybacks. As I've always understood, a piggyback should be administered as a secondary line, but these are often ordered on patients who are saline locked and do not have a primary line.
In addition, even when running as a primary, we were taught initially to prime the line with a small amount of normal saline to avoid wasting medicine when trying to get bubbles out. It is, after all, part of our protocol to flush lines a couple times a day with a 10CC flush, so no one thought any differently of a few CCs of saline to prime tubing.
However, our hospital has decreed that this is "nurses practicing medicine" and that we are not allowed to do so. I do understand their point, but I also see how frustrating it is from the point of a nurse to waste small piggybacks like iron in an attempt to get air bubbles out of the line.
I've worked in several places and had never had an issue with line priming with saline, so I wanted to see, from the allnurses standpoint, your thoughts and how things typically work at other facilities.
The saline flushes at my facility say "rx only." Not sure how that could be interpreted as not needing an order for it. We have standing orders to use flushes but yes. It is something that requires an order.
The "Rx Only" on medical devices is the FDA approved alternative labeling for "Caution: Federal law restricts this device to sell by or on the order of a licensed healthcare practitioner", which is actually much different than a drug prescription requirement. When your hospital buys restricted medical devices, they actually buy them under the name of an MD, usually the medical director. Insulin syringes fall under the same regulation, however you don't need a separate order to use an insulin syringe when administering insulin, as this regulation only applies to the sale, not the use of these devices. Once these devices have been purchased, hospitals and other providers are not required to have a MD order for use, but they are required to keep them secure, which has always been a difficult to define issue and why you'll find some hospitals requiring the flushes be kept in the pyxis or otherwise locked up.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
*** In that case JC is wrong. I know it doesn't mean you still don't have to follow their guidelines. In the case the OP is talking about the NS is being used to occupy space, not treat the patient for anything. As such it is a medical device, not a medication. It sure as all heck is NOT nurses practicing medicine as is claimed by the hospital administration in the OPs case.
I would think that one easy way around such moronic declarations by administration would be to create a hospital wide standing order.
Actually TJC position is and has been since 2006.......
It can be covered by a flush policy or protocol. Remember, saline flush (and heparin flush) are not considered drugs by the FDA or TJC - they are medical devices/supplies.
However, they are referring to the single pre-drawn saline syringes. Hanging a "secondary IV" as a primary IV flush requires either A) a MD order OR B) covered by policy and procedure with pharmacy and therapeutics....for that is considered initiating IV therapy.
MunoRN, RN
8,058 Posts
The "Rx Only" on medical devices is the FDA approved alternative labeling for "Caution: Federal law restricts this device to sell by or on the order of a licensed healthcare practitioner", which is actually much different than a drug prescription requirement. When your hospital buys restricted medical devices, they actually buy them under the name of an MD, usually the medical director. Insulin syringes fall under the same regulation, however you don't need a separate order to use an insulin syringe when administering insulin, as this regulation only applies to the sale, not the use of these devices. Once these devices have been purchased, hospitals and other providers are not required to have a MD order for use, but they are required to keep them secure, which has always been a difficult to define issue and why you'll find some hospitals requiring the flushes be kept in the pyxis or otherwise locked up.