Best flush for small-volume IV medications

[Ellekat2]

With small-volume (50ml) antibiotics such as Invanz and Cubicin, I have always hung a primary 50ml NS and put the antibiotic on as a secondary.

I am now working in an outpatient department. The nurses here hang the antibiotic as a primary and use a NS flush (10ml) to flush in the rest of the med when the med hits the cassette. Is this safe? I can't find any info on it. We have a mix of peripheral lines and central lines. My feeling is that there is a risk of sending air through the line, plus the 10ml isn't enough to send all the medication in.

Your thoughts on this?

[MunoRN, RN]

I don't think the correct process should be any different in outpatient where only a single dose will be given with that it is for inpatient.

The first problem is the initial priming of the line, I've had nurses swear up and down that they can prime tubing without wasting a single drop, then watch as they let 15 ml or more drain into the garbage can while priming. That's no big deal if it's just NS, but if it's 15ml of a 50ml antibiotic then that's a huge deal. Add in the 15ml left in the line when it's done and you just gave the patient 20ml of a 50ml antibiotic. You also have to consider the pharmacokinetics of the antibiotics and that to be both safe and effective antibiotics typically need to infuse at a certain rate.

Flushing in the remainder using a flush syringe on a port will infuse the medication much faster than intended. So really, to use just primary tubing and avoid these problems you would need to prime the line with a separate NS bag, toss that and hang the antibiotic, then spike another NS bag to infuse the remaining antibiotic at the proper rate. For both cost and workload it's probably more sensible to just add a secondary tubing (which costs us 31 cents).

[Ellekat2]

Thanks for your thoughts. I had asked about the rate and was assured that they push the normal saline flush "slowly"-probably still not at the recommended rate. I will continue to administer the meds "my way". Their argument is that it is cheaper for the patient to do it with the saline flush. I'm sure I will hear about it from a supervisor soon, so I want to be able to explain why I think it is safer to do it as I'm doing it now.