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.

[BeckyESRN]

There are times when certain types of lines/ports/and other placements are ordered to be flushed with heparin or have heparin instilled after use to keep the line patent. Heparin flushes are ordered, rarely in my personal experience, but not unheard of. You can always ask! "Hey nurse person, I heard you say that you're flushing that with heparin. I've never seen that done before, do you know why they've ordered that instead of saline?" As long as you approach from a standpoint of wanting to expand your knowledge and not a "hey you're doing this wrong" standpoint, I don't think a normal person would react badly

[PixieRN1]

I have worked in two facilities where very low unit heparin flushes were used for regular IVs. Anywhere from one unit heparin per ml to 10 units per ml. It is not a super common practice, but it is absolutely not unheard of. It may very well be that facility's standard of practice.

I would not be concerned.

[cleback]

I wasn't responding to the OP I was responding to another poster AEB the fact that I quoted her. And seriously? "For heaven's sake" is about as mild as it gets.

I know. And yes. "Oh for heaven's sake!"--discourteous and unnecessary.

[Wuzzie]

I know. And yes. "Oh for heaven's sake!"--discourteous and unnecessary.

Well at least I didn't tell the OP she didn't "know what she was talking about".

[Sour Lemon]

Well at least I didn't tell the OP she didn't "know what she was talking about".

...but she doesn't know what she's talking about.

[Wuzzie]

...but she doesn't know what she's talking about.

Well true, but there was probably a more courteous way to say it. You know since we're all worried about that.

[CelticGoddess, BSN, RN]

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.

That sounds like clysis to me. When I worked in a SNF, we would use clysis on some of our older residents who had horrible veins. It's easier on the resident than having to be re-stuck all the time for a blown IV. I don't necessarily see the problem.

[Mavrick, BSN, RN]

Let's see now. Why do we bother flushing lines?

Usually we are talking about IVs which are generally in veins. We flush them with Saline (or used to use 100u/ml Heparin) to keep blood out of the catheter and prevent it from clotting inside the catheter, making the catheter un-useable.

A catheter that is placed subcutaneously will have little likelihood of getting blood backed up into it. If the catheter is routinely flushed with Saline there is no reason to flush before a medication injection. Just flush afterward to ensure all the medication was given.

[Julius Seizure]

What is your dilemma, OP? Are you wondering if you should report this event or something?

[Apples&Oranges]

I seriously don't even understand what the question is? Flushing with heparin as opposed to saline? If a pt is on a SQ morphine regimen, isn't he/she palliative or hospice? Why is the OP concerned? I worked at a place where a heparin/saline mix was used to flush EVERY peripheral IV every time, before the heparin shortage of 2006. The shortage was why we stopped using heparin routinely, not for any clinical reason. I'm not getting the point of this at all. Can someone enlighten me?

[NightNerd, MSN, RN]

...Maybe things were different where I was veggie, but when we used subcuts they were dedicated to a specific medicine. One for morphine, one for Ativan, etc. No flushing involved; just one line primed with the med, and one syringe to give the med thereafter.

In any case, I agree with other posters that this is not a problematic situation, and encourage theOP to ask questions immediately after such encounters from the people involved to learn from them.

[PixieRN1]

As I stated in your previous post with the same question, while it is not too common to use heparin flushes anymore, some places do use very low unit heparin in their saline flushes for non-central IV access (one unit per ml to 10 units/ml). I have worked at two hospitals that have done this. I do not see a problem here.

In your previous post you mentioned that you are not a nurse. What is your concern for the patient then?