I had NO order to flush the peripheral line with heparin and therefore did not and refused to do so.
The nursing supervisor then wrote in the orders "flush line with heparin" "(SASH).
Later, found out that the pt. is also on coumadin.
I asked, where is the policy and procedure book in relation to flushing lines, it was not produced either. I was then told that in LTC this is how we do it, this is not a hospital.
I just want to know, is this right?
Are Peripheral lines flushed with 5ml of (100units/ml) of heparin?????? I thought only PICC and central lines.
Peripheral lines are SHORT TERM not long term and can be maintained with Normal saline, RIGHT?????
I also, witness the nurses writing there own medical orders and later having the MD sign them.
I refuse to do that also, I will only write an order if I received it from the MD even as simple as tylenol or maalox.
I also received an order from a MD to give 1mg of morphine to a pt with pulse O2 of 84-86% room air.
I refused to give that also, when I stated to the unit manger that it woud depress her respirations even more, she disagreed.
They later gave the morphine after I left and the pt. died.
I heard one nurse state that is was for the pain, but the pt. was not in pain and another then said, it was a mercy killing.
So, yesterday, I had a patient on comfort care he denies pain but, I was told to give her Roxanol PRN and they kept saying it, as if I was not going to look it up- IT"S MORPHINE! This is against my morals and values I do not believe in mercy killing although I try to understand the views of others, it is not my place to decide.
Specializes in cardiac/critical care/ informatics.
If you give morphine to an opiate-naive patient with a sat of 86%, you will indeed depress the respirations and cause further problems. However, I've had some COPD'ers that "live" at around 86%, so whether I'd give it or not really depends on a few variables.
SHe said it was an order for 1 mg of morphine, it would have helped them breath easier, besides she never said the pts resp. rate was
There are legitimate safety concerns to justify using saline vs. heparin to flush piv's but the risk of HIT is not one of them. Anyway I was addressing the significance of giving heparin to someone on coumadin. Thank you for the link, it is informative.
HIT can occur with any heparin exposure, including heparin flushes, heparin-coated catheters, and heparin given via the intravenous or subcutaneous route.
Thank you for the links. I didn't realize the morbidity was so high - up to 5% - in patients receiving long term treatment. I take it back, heparin flushes for PIV's have an new (to me) contraindication.
Thank you for the links. I didn't realize the morbidity was so high - up to 5% - in patients receiving long term treatment. I take it back, heparin flushes for PIV's have an new (to me) contraindication.
It's rare, I'm sure. But considering HIT is an immune response it makes sense that any exposure can lead to it.
I've had at least 2 patients in the last couple of years who developed HIT with nothing more than IV heparin flush exposure (they were on no other forms of heparin). One was PIV, the other had a portacath. The problem we had was that our patients so often have multiple medications, IVPBs and direct pushes, that they ended up receiving pretty high cumulative doses of heparin.
Also had a patient who was receiving subcut heparin, and ended up with HIT. The on-call doc for that weekend then switched him over to Lovenox. We had to get the heme/onc consultant to explain why that was not such a grand idea (he wouldn't listen to the nurses, of course...)
jmgrn65, RN
1,344 Posts
SHe said it was an order for 1 mg of morphine, it would have helped them breath easier, besides she never said the pts resp. rate was