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

Nurses Safety

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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.

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

Ok, what is the real issue here? You've posted this same thing twice. Are you trying to find something wrong with this nurse? Several posters have already explained that this nurse was probably correct, but you're still not satisfied? I'm getting a freaky-dink feeling about all of this. I think you probably need to back off the nurses and do whatever it is you're hired to do.

Specializes in Nephrology, Cardiology, ER, ICU.

Merged both threads, same topic.

From your other thread (about staff sleeping on night shift), please report this as many posters have urged you to do.

Specializes in Med-Tele; ED; ICU.

Here's my take on it:

1) It may or may not have been heparin... only the person drawing up the med or holding the phial/syringe knows what it is.

2) Presuming it was: Perhaps it was ordered that way... I can't see why but it's not out of the question

3) Presuming it was an error: It's pretty minor as such things go... an extra couple hundred units of SQ heparin is not likely to cause anybody any harm

4) What is the dilemma?

Cambridge University Press: "dilemma = a situation in which a choice has to be made between possibilities that will all have results you do not want"

Well, I find it peculiar to flush SC butterfly with heparin but I have limited experience with palliative care.

Next time, ask the nurse directly to explain it to you. Questions are okay, and should be accepted. At this, point, next time you go to the facility, you might ask about it. If you're not going, go ahead and call. Explain what you saw and that you would like to better understand. Update us! Thank you!

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.

A heparin flush is not the same as being dosed with heparin for anticoagulant therapy. The heparin flushes are diluted and used simply for maintaining a line.

In this case it must have been an INT (INT meaning intermittent/not running fluids). So they flushed it, pushed the med, then Hep locked the extension (meaning they filled the extension and catheter with heparin flush and capped it off).

What was described sounds completely fine. What I found interesting is that they had abdominal IV access, good job whoever found that.

Specializes in cardiac-telemetry, hospice, ICU.

I worked a while for Hospice.. We used sub Q to administer morphine on a continuous drip. The rate need to be very low (in volume). Sub Q injections by their very nature go into spaces that don't exist, they 'make their own space'. I have never seen a sub Q site flushed, heparin or otherwise, it would do damage to the skin. In fact, SubQ sites go 'bad' quite quickly, often the site is changed daily. We used a tiny TB type needle mounted on a plastic base that adhered to the skin by a peel off sticky base.

Maybe the OP was seeing a type of true IV, and of course flushing would be done. As a hospice nurse I never used a peripheral IV. I would on rare occasion access a port or Picc if the patient came with it.

Specializes in Med/surg/ortho.

Uh maybe ask the nurse what he's doing. Ask lol. It's ok to Ask questions. If your that paranoid about it why wouldn't you just ask. The heparin was probably saline and that's what your supposed to do. There are some situations where u would flush with heparin but not usually unless they have a port or a picc that's not working.

Actually Sub-q sites are flushed and rotated every 3-5 days depending on the facility's protocol. OP did say this was an IV, so I think we are actually off topic talking about sub-q sites. If OP worked in such facility they would not be privy to nurse's patient care as this occurs behind closed door, or should be unless OP is not actually telling the truth here. Why not ask the nurse to explain what is happening while it is happening.

I have a feeling the flush was just saline and the nurse (probably a nurse who has been around for awhile) called it heparin because that is what flushes used to be. Otherwise that procedure sounds 100% correct.

What is your role in this situation and why are you so concerned with it?

I think EllaBella1 has a great point. I think more experienced nurses in my hospital and older doctors still say "Hep lock the patient's IV"--even for your basic peripheral IVs. In fact the other day, a surgeon entered nursing instructions" "HLIV," and verbally told me to hep lock her IV.

At my Southern Californian Magnet hospital, we saline lock the basic (short) peripheral IVs but hep lock long midline peripheral IVs and central lines as long as there's no HITT suspected.

What I am curious about the scenario you mentioned is how an IV cath was used in the pt's abdominal fat tissue so that morphine can be given subQ. I wonder why is an IV cath in the pt's abdomen for subQ med administration? At my hospital, we use subQ needles that we stick in the patient's abdomen and stay there for some days for comfort care/end of life care med admin. I have to say I have not seen a situation like yours--maybe because I have only been a nurse for 5 years.

These responses are nasty. All you had to say was "No this is fine but how about you go and ask the nurse why we flush with heparin" .. wow. Disappointing from a bunch of nurses. Below the line..

Specializes in Med-Tele; ED; ICU.
These responses are nasty. All you had to say was "No this is fine but how about you go and ask the nurse why we flush with heparin" .. wow. Disappointing from a bunch of nurses. Below the line..

Not nasty at all... just direct.

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

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