Something my clinical instructor said...

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I was wondering if it is normal for a nurse to run a primary of NS at 10ml/hr when you are hanging a small bag of antibiotics (50ml), when there is no order for the NS to begin with. My pt had no fluids running or any order for fluids but my instructor said to hang the NS and back prime to avoid wasting a significant amount of the atb priming and then just set the rate for the NS at 10ml/hr. She said some nurses don't feel comfortable doing this...is it because it's illegal?

Specializes in Hospital Education Coordinator.

I think your question is can you hang NS without an order. The answer is : maybe. Depends on SO MANY factors, including policies and standing orders, etc.

In our facility we do not backprime. At least, that is our policy. Some people have fluid restrictions and, like you said, who is paying for this? There is also the chance of the ATB reversing to the NS bag and the patient gets less medication than expected.

Once I measured the amount of NS in the tubing, with an extension, and learned it was

Specializes in Emergency Department.

If there's no order for IV fluid to run with the ABX, I'd first check the facility policy/procedures to see if there's a facility protocol that covers the practice of hanging an NS flush with the ABX. I know that at least one or two of the facilities I've done my clinical time at, they had a protocol that covered this, so that any patient receiving IV antibiotics would also have a NS primary hung at the same time as the antibiotic to ensure that all of the ABX was delivered and also to prevent air from entering the line. Once the infusion was done, the Primary could continue running at 20 ml/hr or you could simply convert the line back to a lock.

If there is no such order/policy/procedure there, while it would be good practice/standard of care, I would refrain from doing this because I'd then be giving a medication without an order.

Specializes in Med-Surg, Emergency, CEN.

Standard of care: flush the IV to check patency, give medication, flush IV again. No MD order needed.

How is it different if you flush the IV with a pump or with a syringe? If you do not use the NS to flush the pump line, the patient misses up to (as earlier stated ) 17ml of antibiotic from what is left in the IV line. You have to push it through with about 10ml of flush from a primary bag.

Are they talking about running the 10ml concurrently throughout the infusion? Then I would agree that not I do not do it that way.

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