flushing iv

ocdstudent · Jan 29, 2015

was told to remove ivpb and flush line iv. I forgot to swab the port almost forgot to get air bubbles out of syringe actually had to unscrew from port and expel air. then I flushed iv no immediate problem with it or problems a little while later when I went to check on them. but I have been worry how likely is the patient to get an infection from it, if they do will they die, will I get kicked out of nursing school for forgetting to be prepared, will I get sued

Editorial Team / Admin · Jan 29, 2015

Swabbing the port: how long was it between removing the IVPB and doing the flush? Did the port touch anything? There have been some conflicting stories out there about the effectiveness of swabbing IV ports, and for it to be effective, it has to be done for at least 15 seconds. My guess would be is that there are a lot of nurses out there who don't swab for a full 15 seconds (and if you come watch the anesthesiologists I work with, there is no such thing as swabbing), and infections aren't being seen in crazy numbers.

Air bubbles: it's going to take a lot of air to cause a problem. The air bubble in a pre filled syringe is not likely to cause a lot of damage, if any. https://allnurses.com/general-nursing-discussion/air-in-iv-464048.html

anh06005, MSN, APRN, NP · Jan 30, 2015

I think Rose_Queen hit the nail on the head. If I immediately disconnect from an IV port, keep it in my grasp and it doesn't touch anything, I will skip swabbing and flush immediately. My thoughts: the hub was JUST connected to the IVPB which is clean. If it does not touch anything then the hub remains clean.

If it's questionable or patient coughs in my direction, etc. yes I swab again because of potential contamination.

As far as air bubbles I don't know how much it takes to kill somebody but I know I've heard it's not like in the movies. I teach patients about doing IV's in home and they often worry about bubbles small bubbles. I have 2 rules I tell them:

(1) keep everything clean when working with the IV port

(2) don't let everything run dry

Anything else can be fixed except possible infection (which as Rose said isn't highly likely) and air embolism (which would take a decent amount of air).

RunBabyRN · Jan 30, 2015

Yup, what they said.

There is little chance, especially if you'd just disconnected the IV tubing, that there was a big opportunity for infectious bacteria to get onto the hub and infect the patient. One trick I do (I do home infusions) is leave anything connected until I have the next thing ready (so leave the flush syringe attached, for example). You don't have to scrub the hub in between everything, just hold it stable so it doesn't touch anything.

Also, if you forget to prime the syringe (happens all the time), try holding it with the plunger side up, so the bubble floats up, and don't push in the plunger all the way. Even that little ml of air won't do anything, but it's good practice not to get into the habit of injecting air into people. :)

Also, don't forget to cap the tubing when you disconnect the patient. When in the hospital, I carry caps in my pocket, but you can often use the cap off of the flush in a pinch.

rob4546, ADN, BSN, MSN · Jan 31, 2015

and if you come watch the anesthesiologists I work with, there is no such thing as swabbing), and infections aren't being seen in crazy numbers.

Same here. I cringe every time I see a CRNA attach to a port without cleaning it first. Maybe because I am still an idealistic nurse I always clean, clean, clean.

As far as air in a line, the consensus at work is that it would take 30-80 ml of air at one time to create a problem.... I don't worry about tiny bubbles.....

RunBabyRN · Jan 31, 2015

Same here. I cringe every time I see a CRNA attach to a port without cleaning it first. Maybe because I am still an idealistic nurse I always clean, clean, clean.
As far as air in a line, the consensus at work is that it would take 30-80 ml of air at one time to create a problem.... I don't worry about tiny bubbles.....

But the pumps sure hate them! :arghh:

traumaguy8 · Jan 31, 2015

You most certainly chose an appropriate username.

TheNGTKingRN · Jan 31, 2015

You most certainly chose an appropriate username.

Lmao. I've forgotten to swab a couple of times. If I was the OP I'd have a CVA by now.

OP, hey OP ... yeah ... chilllllllll outtttt. No worries man (Jamaican accent) ... your pt will most likely not get an infection and if they did they will not suspect you lmao.

I can't EVEN express how minute this is compared to other things that can go wrong.

You need relax a little bc as a nurse you'll do tons of things to make you say "oh s+Ã—Ã·".

anh06005, MSN, APRN, NP · Jan 31, 2015

Lmao. I've forgotten to swab a couple of times. If I was the OP I'd have a CVA by now.
OP, hey OP ... yeah ... chilllllllll outtttt. No worries man (Jamaican accent) ... your pt will most likely not get an infection and if they did they will not suspect you lmao.
I can't EVEN express how minute this is compared to other things that can go wrong.
You need relax a little bc as a nurse you'll do tons of things to make you say "oh s+Ã—Ã·".

Yes. I love the port kits that don't come with NS in them. The other flushes aren't sterile. I like flushing /filling my hubers before inserting. Nursing ain't perfect and things aren't like in textbooks so I just do my best in these situations

nurseprnRN, BSN, RN · Jan 31, 2015

Body > Veins > Vena Cava > Right Atrium > tricuspid valve > Right Ventricle > pulmonic valve > Pulmonary Artery > LUNGS >Pulmonary Vein > Left Atrium > mitral valve > Left ventricle > aortic valve > Arteries > Body

Given normal anatomy, i.e., no intracardiac malformations, there is simply no way for a floating object to get to the left heart at all; it gets strained out in the pulmonary capillary bed. As a matter of fact, that's why you have a pulmonary capillary bed, to act as a strainer for all the microemboli you have in the course of an active life. Air bubbles there, unless so huge that they completely fill a pulmonary artery, will be absorbed and vanish in short order.They will not accumulate over the course of a lifetime. :)

The only way a venous DVT (or a bubble in an intraVENOUS line) can get to the cerebral arterial circulation is if there is a direct connection between the venous side and the arterial side in the heart AND the venous pressure is HIGHER than the arterial pressure.

Anyone with an atrial or ventricular septal defect AND a right-to-left shunt, would be at risk for arterial embolus of venous origin, and this would be bad. However, since in most people, the left heart pressures are significantly higher than right heart pressures (by a factor of five to ten, more or less), any air or clot in the right heart keeps going right on out the pulmonary artery to the capillary bed. Unsuspected ASDs are a known cause of stroke in younger people who lack other risk factors-- think of the much-beloved erstwhile heart and soul of the Patriots' line, Tedy Bruschi, whose stroke fortunately resolved and whose ASD was repaired endoscopically; he went back to football for the rest of that season and all of the next one (although he has since retired to TV commentating and shilling for a local MRI chain). His clot probably got over to his left side when he was crushed at the bottom of the pile-- think a major Valsalva, which would make right sided pressure momentarily exceed left sided pressure, resulting in a R-to-L shunt.

As a matter of fact, most ASDs are found by accident or on post for unrelated issues, since the left-to-right shunt doesn't do much harm unless it's so huge that you get bad pulmonary hypertension and capillary bed damage (seen in single ventricle, for example).it is very important to realize that because left heart pressures are much higher than right heart pressures, a bubble (or clot) in the right side will not travel to the left side. This is one reason you have a pulmonary capillary bed, to strain out such things (You have little clots traveling about all the time; they don't grow bigger in the lungs because there are natural anticoagulants manufactured there for that purpose. Anyone remember when all our heparin came from beef lungs?)

TheNGTKingRN · Jan 31, 2015

Body > Veins > Vena Cava > Right Atrium > tricuspid valve > Right Ventricle > pulmonic valve > Pulmonary Artery > LUNGS >Pulmonary Vein > Left Atrium > mitral valve > Left ventricle > aortic valve > Arteries > Body
Given normal anatomy, i.e., no intracardiac malformations, there is simply no way for a floating object to get to the left heart at all; it gets strained out in the pulmonary capillary bed. As a matter of fact, that's why you have a pulmonary capillary bed, to act as a strainer for all the microemboli you have in the course of an active life. Air bubbles there, unless so huge that they completely fill a pulmonary artery, will be absorbed and vanish in short order.They will not accumulate over the course of a lifetime. :)
The only way a venous DVT (or a bubble in an intraVENOUS line) can get to the cerebral arterial circulation is if there is a direct connection between the venous side and the arterial side in the heart AND the venous pressure is HIGHER than the arterial pressure.
Anyone with an atrial or ventricular septal defect AND a right-to-left shunt, would be at risk for arterial embolus of venous origin, and this would be bad. However, since in most people, the left heart pressures are significantly higher than right heart pressures (by a factor of five to ten, more or less), any air or clot in the right heart keeps going right on out the pulmonary artery to the capillary bed. Unsuspected ASDs are a known cause of stroke in younger people who lack other risk factors-- think of the much-beloved erstwhile heart and soul of the Patriots' line, Tedy Bruschi, whose stroke fortunately resolved and whose ASD was repaired endoscopically; he went back to football for the rest of that season and all of the next one (although he has since retired to TV commentating and shilling for a local MRI chain). His clot probably got over to his left side when he was crushed at the bottom of the pile-- think a major Valsalva, which would make right sided pressure momentarily exceed left sided pressure, resulting in a R-to-L shunt.

As a matter of fact, most ASDs are found by accident or on post for unrelated issues, since the left-to-right shunt doesn't do much harm unless it's so huge that you get bad pulmonary hypertension and capillary bed damage (seen in single ventricle, for example).it is very important to realize that because left heart pressures are much higher than right heart pressures, a bubble (or clot) in the right side will not travel to the left side. This is one reason you have a pulmonary capillary bed, to strain out such things (You have little clots traveling about all the time; they don't grow bigger in the lungs because there are natural anticoagulants manufactured there for that purpose. Anyone remember when all our heparin came from beef lungs?)

Beautiful explanation! As always GrnTea!