Administration vs nurses: priming lines with normal saline

Nurses General Nursing

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There is a huge blowup at my hospital lately about the practice of priming an antibiotic line with normal saline first.

The nature of our EMR system automatically names some things - like Zosyn, Iron, and K-riders - piggybacks. As I've always understood, a piggyback should be administered as a secondary line, but these are often ordered on patients who are saline locked and do not have a primary line.

In addition, even when running as a primary, we were taught initially to prime the line with a small amount of normal saline to avoid wasting medicine when trying to get bubbles out. It is, after all, part of our protocol to flush lines a couple times a day with a 10CC flush, so no one thought any differently of a few CCs of saline to prime tubing.

However, our hospital has decreed that this is "nurses practicing medicine" and that we are not allowed to do so. I do understand their point, but I also see how frustrating it is from the point of a nurse to waste small piggybacks like iron in an attempt to get air bubbles out of the line.

I've worked in several places and had never had an issue with line priming with saline, so I wanted to see, from the allnurses standpoint, your thoughts and how things typically work at other facilities.

hrumph! I am older than most of the "crusty old bat" society here, and I am with you on the running a bag of saline and all the abt secondary....so these idiots not only want to go against best practice, they want to spend the money on multiple primary sets per day, when one would do? Yes, it is truly about money, and until, as Muno said, they have to pay out for increased infections, they wont care.

I can remember getting "creative" and running several ABT through one Y port, leaving them connected, to cut down on the in and out, there fore decreasing infection poss.; had to label well though, lol. Admin. needs to keep their noses out of our business. However, the priming issue is really secondary, (pun intended) there would only be a small loss in the initial dose for the day, what was left in the tubing would be adm. in the next dose. Admin needs to understand that your way is more eff. and safer! A good combo!

It all comes down to saving money. I believe the decision should be at the discretion of the practicing nurse.

Specializes in Med-Surg, Emergency, CEN.
It's not about better or best practice or any SILLY thing like that.

It's about money.

THIS!

We run the ABX as the primary if they don't have fluids but the tubing is still only good for 24 hours.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
However, our hospital has decreed that this is "nurses practicing medicine" and that we are not allowed to do so.

*** You work for morons. In the case the NS is NOT a medicin or drug or treatment, it is a device used as a place holder. This is why your NS flushes are (or should be) kept in the supply room and not the med room. They are a medical device and NOT a treatment.

I do understand their point,

*** You do!? Wow. They are wrong and mis-informed. Your administration has no point.

Specializes in Medical-Surgical/Float Pool/Stepdown.

My other question is, how does everyone out there run their drips? If I have a Lasix drip running at 5mg/hr (5ml/hr), would you run this as a secondary?

Always, but in our MAR the Lasix gtt is set up to run concurrent with 0.9 NS so you would have to scan both when hanging. I think the main topic shows a lack of general nursing autonomy in the work place. I have always ran antibiotics as secondary and we have a protocol in place to hang 0.9 NS if there is not an MD order. I do heplock in between or put the pump on standby when only antibiotics are ordered though. All IVF is recorded in the computer each shift too.

Specializes in Medical-Surgical/Float Pool/Stepdown.
The question I answered was not referring to intermittent antibiotics but drips. Drips are continuous in most cases, so they should not be on a secondary or piggyback if the pt also has maintenance IVF running..

Our Lasix gtt comes in 10cc syringe doses that have to be piggybacked into a primary tubing so theres no other way to run it, hence the cuncurrent order for 0.9 NS. (I know this falls into not "most cases") :saint:

Just for shouts and giggles, to paraphrase, sometime actually measure the volume that IV tubing holds. Hint: It's not twenty cc.

Also, the Infusion Nurses Society standards are your best bet for EBP on this issue. Get the pharmacy to buy it, or you can take it as a tax deduction. Don't balk-- it's about what they'll charge for a 500cc bag, maybe less. Infusion Nursing Standards of Practice - Infusion Nurses Society

Nursing 2013 article on same:

Are you up-to-date with the infusion nursing standards? : Nursing2013

*** You work for morons. In the case the NS is NOT a medicin or drug or treatment, it is a device used as a place holder. This is why your NS flushes are (or should be) kept in the supply room and not the med room. They are a medical device and NOT a treatment.

While I agree with this, it must be a regional interpretation. According to our last JC visit, NS flushes are a medication.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
While I agree with this, it must be a regional interpretation. According to our last JC visit, NS flushes are a medication.

*** In that case JC is wrong. I know it doesn't mean you still don't have to follow their guidelines. In the case the OP is talking about the NS is being used to occupy space, not treat the patient for anything. As such it is a medical device, not a medication. It sure as all heck is NOT nurses practicing medicine as is claimed by the hospital administration in the OPs case.

I would think that one easy way around such moronic declarations by administration would be to create a hospital wide standing order.

Specializes in Med/Surg,Cardiac.

The saline flushes at my facility say "rx only." Not sure how that could be interpreted as not needing an order for it. We have standing orders to use flushes but yes. It is something that requires an order.

As far as running an abx as a piggyback, I don't see why you wouldn't. Example: I had a patient come in for outpatient Rocephin infusions. I hung a 100 ml bag of NS to prime my line and hung the 50 ml bag of Rocephin as a piggyback. The patient received the entire 50 mls of antibiotics. I let the remainder of the minibag run in afterward to flush the rest of the medication in. The patient then complained about how previous nurses didn't do this and she felt cheated out of medication, which is expensive. I agreed but offered an apology.

If I were the one paying out of pocket for IV antibiotics you bet I want my entire dose, which I wouldn't be getting if I still had even 5 or 10 mls left in the line.

Specializes in Critical Care.
While I agree with this, it must be a regional interpretation. According to our last JC visit, NS flushes are a medication.

The Joint Commission actually has no regulatory authority, the definition of a "drug" is determined by the FDA. The FDA changed the classification of saline flushes from "drug" to a "device" in 2006. In my experience if a JC surveyor is no more than 10 years out of date then they are considered more up to date than average.

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