flushing question

miphillli · Nov 4, 2005

I agree with meown,It is easier to flush before and after each time,and I also give every Iv push med,slowly-3-5min ea.unless otherwise stated. Longer is better and safer!

LISAMAR · Nov 4, 2005

The only thing I can see wrong with attatching the 250 bag of saline is that it could be considered a wasteful charge to the patient. I don't know about a 250cc bag, but I heard that the 1,000 cc bags are expensive aren't they?

pricklypear · Nov 4, 2005

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.

There really is no reason to pinch the maint. line that is on a pump. Even if the med does back up into the tubing(which it won't, if you're not pushing too fast), it will eventually get to the patient anyway. If you're pushing fast enough to put back pressure on the pump, it will alarm. Like Larry77, I usually give pushes into a midlevel port instead of the most proximal one - to further dilute.

Your instructor may just be of "the old school" where most IVs were hung to gravity, and the drip regulated by hand. In that case, you would want to pinch the primary.

Saline locks should ALWAYS be flushed before (to assure patency) and after (to assure the pt gets all the med, and refil the extension with saline only). There really is no reason to flush a maintenence line before or after. It the med is incompatible, the maint. line should be disconnected, the extension flushed before and after, then reattach the maint. line.

As to hanging saline with antibiotics, that seems to be an institution thing. The first hospital I worked for never hung saline for that, but the one I'm working for now almost always does.

Brotherbob, BSN, RN · Nov 4, 2005

We often hang by gravity and yes I pinch, otherwise the med is backing up in the tubing and filling up the chamber (or whatever that is called) where you see the drops and you can´t see how fast the fluid is running.

KatieBell · Nov 4, 2005

Couple of ideas:

Yes, when fluid is running off a pump (as it often the case in the ED- where I also work), I do sometimes pinch off the line, push and then let it run, push again, and let it run, until the med is in.

hanging 250 cc of extra saline as you describe (and I may be getting it wrong- would have to see it) is a bit risky. For many types of patients 250cc is a lot of extra fluid and can throw them into fluid overload. You probably have not had these patients in clinical, but you will have them as a nurse.

Thirdly- read specifications before assuming anything about meds. Slow is usually, but not always, better, if you give adenosine slowly-then you might as well shout into the wind- you will not get any result. Again, I think Adenosine is a drug you are unlikely to be giving in clinical, but who knows?