Don't flush saline lock? I'm confused.

[boggle, ASN, RN]

Hi All, I've been doing something the same way for years but now I'm not sure it's needed.

When IV solution is discontinued and patient is to just have saline lock, I've been unplugging the IV line and flushing the remaining saline lock tubing with 2.5 cc of normal saline. The lock is then flushed q8hours.

Recently a new employee said if the IV running was normal saline, there is no need to flush the lock when converting to saline lock, just turn off the IV and unplug the tubing.

I have not been able to find any documentation supporting this. What do you folks know about this? Can you tell me what is current practice?

I hate to keep doing things just because "We always do it that way". Gotta know why!

[EricTAMUCC-BSN, BSN, RN]

The new employee has a good point, but what if the fluid in the lock drains out while you are removing the tubing? What if there is some backflow into the lock?

[OzNurse69]

As long as you turn off the tap on the IV while the N/S is still running, this is perfectly fine.

Doesn't apply for positive pressure lock devices though, which need the fluid to be injected under pressure.

HTH.

Ruth

[northernexposure]

Well Ruth, I can't find any evidence either. If I've just infused something running at 150cc/hour, I don't flush after. My colleagues, however, all say they were taught to flush before and after infusions. I'd like to know if it's necessary though also. I'll keep searching.

[MaraG.]

When I was in school, 3 years ago, I was taught to always flush. This created negative....... positive.......the correct pressure in the IVI (IV- infuser) It is what I do but with 3cc of NS q8h.

[Virgo_RN, BSN, RN]

I would flush after anything that is not NS. If NS, I would look at the pigtail. If there is visible blood in the pigtail, then yes I would flush and clear the line. If not, I would see no need to flush. Of course, I have no evidence on which to base this practice. We use positive pressure caps, BTW.

[Otessa, BSN, RN]

I have to say that if someone had an IV running with NS-and there were no problems with it running then I would only flush it every 8 hours-not at the time of disconnection.

otessa

[Whispera, MSN, RN]

I'm picturing this....you have saline flowing into the person and are discontinuing the bag...to flush with saline is just putting more of what's already there into the person, and seems redundant. I can see if there's backflow of blood then you would need to flush to prevent the blood from clotting in the tubing, but if there isn't, you don't need to flush it. On the other hand, maybe there's a tiny bit of blood in the tiny tubing that's inside the skin/vessel that might clot there, so flushing wouldn't hurt.

[JRD2002]

I always flush after disconnecting even if it is NS. I have no hard evidence on why to do this but it only takes a second and using a push/pause method ensures that the IV angio is free from blood and helps to decrease the chance of fibrin sheath formation. I would rather take a few extra seconds than having to spend 5-10 minutes starting another line on my patient.

[GrumpyRN63, ADN, RN]

I flush anyway just to be on the safe side there may be some blood/fibrin not visible and like to do a positive pressure just to be sure. It may be overkill, but it won't hurt, I'd rather just do it then take a chance and lose a line.

[Higgs]

Agreed. It may or may not make any difference at all, but if it means I don't need to spend valuable time (or someone else's) trying to re-insert a cannula into a pt with no veins/oedematous arms/lots of fat/ etc etc, then it's a wise and prudent thing to do.

[iluvivt, BSN, RN]

Yes You should absolutely flush if you are disconnecting any IV fluids...even NS...the act of disconnecting can cause a reflux of blood into the cannula.. and then you go to use it and it is clotted off.....the amt of refux varies based upon the type of needleless cap you are using. as well as other factors...the pulsatile flush also allows you another assessment parameter...b/c if the vein is irritated.patients will often c/o that the flush was painful or achy...so the standard of care is to flush b/c the turbulence you create minimizes a small clot forming in the cannula or on the tip of it..