flushing question

veronica butterfly, ADN, RN · Nov 2, 2005

I just learned how to do IV pushes in clinical this semester. My teacher taught us to flush like this if there is a primary maintenance running. Check your compatibility (Dilaudid is compatible with Ringers so K is okay, along with D5, NS, etc.). We connected the syringe with the IV push med in it to the port closest to the hand ( the maintenance is still running) and pinched the tubing above the port, put in a bit of the push drug, then unpinched the tubing so the maintenance fluid "flushed" the push drug through, then pinched the tubing, pushed a little more of the drug, then unpinched and let the maintenance flush it, etc.... This was pretty slick because we never had to unattach tubing from the IV site, less change of contamination for patient.

If it is an IV that is saline locked, then yes you have to flush it before or after. Or if you have a maintenance fluid that is incompatible, you have to unhook your maintenance fluid, flush it with saline and then give the drug which is probably diluted in the syringe with saline or something, flush again and rehook your maintenance fluid.

You'll know how fast to push the drug when you look it up in your drug book--you give Dilaudid 2 mg over 3-5 minutes.

Have fun!

KatieBell · Nov 2, 2005

If it is an IV that is saline locked, then yes you have to flush it before or after. Or if you have a maintenance fluid that is incompatible, you have to unhook your maintenance fluid, flush it with saline and then give the drug which is probably diluted in the syringe with saline or something, flush again and rehook your maintenance fluid.

Flush it before and after, is I think what Veronica meant. Most of the time with a saline lock, you will see nurses just push the drug, then flush after with saline (Otherwise, the drug sits half in the tubing of the lock. But it is usually a good idea to flush with some saline or whatever you are using, to make sure the IV is patent. Always better to infiltrate saline than drugs that could possibly cause problems.

sweetieann · Nov 2, 2005

"Dilaudid is compatible with Ringers so K is okay, along with D5, NS, etc"

I am a nursing student too, and I was just wondering if you could quickly explain what you meant when you said this...like what did you mean that it's compatible with ringers, so K is ok? WHat does K have to do with the ringers? (I haven't had much experience at all with IV therapy...is K a part of LR solution or what?

Thanks so much!

KatieBell · Nov 2, 2005

K stands for potassium. There is some (not a lot) Potassium in LR

If your patient is getting a solution with a large amount of K then flushing that K in to the line rapidly is not a good idea at all, even if it is compatible.

meownsmile, BSN, RN · Nov 3, 2005

Anything given IV push should be administered to the port lowest to the insertion site. Always flush before and after, ill give you an expample.

When a patient comes from surgery, some of the iv meds given in surgery are pushed through the access ports, not all anesthetists flush following administering their drugs. If you attempt to push a med to a port that hasnt been flushed prior, you will find yourself getting a precipitate in the tubing as you push your med. It's happened to me and ive had to change entire lines, followed by a incident report on the anesthetist. You better know how to act fast before the precipitate gets to the patient, i learned the hard way, take my word for it,, ALWAYS flush NS before and after ANY push med.

LISAMAR · Nov 3, 2005

See I just don't understand why I see people doing different things... some nurses will flush before and after and others wont (I'm talking if they have a maintanence going). My actual nursing book doesn't say to flush before or after if there's a maintanence... it just says to pinch-unpinch the tubing to let the maintanence flow with the medicine. All it has is a side note that some hospital policy may require a 1cc flush afterwards.

veronica butterfly, ADN, RN · Nov 3, 2005

Flush it before and after, is I think what Veronica meant.

Ooops, yes, I meant flush before AND after...:imbar

Yes, it seems nurses do things a bit differently, not a lot, just a little. Maybe from experience, maybe because different places have different protocols.

In clinical, I had a hard time finding in my drug book if things were compatible with potassium (my maintenance bag was d5w 1/2 ns 20meq k), and my teacher said if the book says it's compatible with LR lactated ringers, then it is compatible with k potassium.

Antikigirl, ASN, RN · Nov 3, 2005

AMEN MEOWN!!!!!! Yes always flush before and after with a compatible solution...and you ask the reasons for...why not think about the reasons why not...that is always helpful in connecting nursing tx (hint for school there *WINK* it is all about making connections!)...

I mean...I think of it very simplistically....why not start out with a nice clean in that line when it is your responsiblity??? Hmmm? Plus, its just cleaner to flush...get that lovely artifical line as clean as possible with an appropriate solution before hitting with something...just seems cleaner to me....(there is a lot more reasons, but this one just make common sense to me...so I use it!).

Larry77, RN · Nov 3, 2005

Interesting, I was never taught to "pinch" the line while giving an IVP med that is compatible with the maintenence line hmm.. I don't think I've ever seen any nurses on my floor doing that either. When I give an IVP med that IS compatible I tend to administer it in a midlevel port especially if it is a med that can burn. I always administer it slowly usually at least 1 min for every ml, unless it is in literature to go slower. My maintenence fluid is still flushing the med in to the patient like the other poster said happens when she "pinches" the line.

Maybe I'm misunderstanding what the "pinching" does for you beside make your pump scream "occlusion"?

And yes I ALWAYS flush my SL's before administering meds.

onconurseRT · Nov 4, 2005

I always flush before and after regardless of maintenance IV with generous amounts of saline. I push meds slowly as well-- I have had WAY to many patients complain that "they get nauseated after the other nurses give the meds". Pushing iv narcotics slowly will still help their pain and they do not get nauseated for me. :cool: Listen to your patients.

veronica butterfly, ADN, RN · Nov 4, 2005

Interesting, I was never taught to "pinch" the line while giving an IVP med that is compatible with the maintenence line hmm.. I don't think I've ever seen any nurses on my floor doing that either. When I give an IVP med that IS compatible I tend to administer it in a midlevel port especially if it is a med that can burn. I always administer it slowly usually at least 1 min for every ml, unless it is in literature to go slower. My maintenence fluid is still flushing the med in to the patient like the other poster said happens when she "pinches" the line.
Maybe I'm misunderstanding what the "pinching" does for you beside make your pump scream "occlusion"?
And yes I ALWAYS flush my SL's before administering meds.

Interesting, thanks, no i have never seen the line pinched before either and when my teacher taught us this, I too thought Hmmmmm........ She said it is so the push med doesn't back up into the tubing. Well, I thought the maintenance fluid flowing would prevent that if it was going at a good rate. Here's another thing we learned that the staff nurses at the hospital were rolling their eyes over, whaddya think?? If we were hanging an antibiotic only (saline locked iv, intermittent...), she would want us to also attach a 250cc bag of NS and then attach the antibiotic to that. then we could back flush the tubing that was used for the morning run of antibiotic therapy with NS, then hook up our antibiotic as a true piggy back. Also then she said when the antibiotic is done, a bit of the NS will run through if we don't get there exactly when the antibiotic bag is done. Of course after we left the floor, the staff nurses would dismantle our set ups and just run the antibiotic. I am anxious to get a real job and just settle in and learn one way of doing things!! Not whatever the teacher of the month is teaching.