IV Administration of drugs...KVO vs numerous saline flushes??

[LucyLu]

Does your hospital have a policy on IV Drug Administration?? Do you ever keep a line KVO with NS for the sole purpose of piggybacking antibiotics, lasix, steroids, etc.??

Also has there been any research done into this as far as infection rate of frequently accessed ports vs. closed system of IV tubing with piggybacks as well as efficiency of nursing time?

[MarySunshine]

I work in an ICU and if the patient isn't needed IV fluids but they are needing antibiotics/electrolyte replacements, I almost always KVO NS to run them though. There is no way I can be there at the end up every bag to flush our their lines -- it's much safer for their veins to have the NS immediately following the meds. I wouldn't do this if they're on severe fluid restrictions, in which case KVO could add up for them.

[Nemhain]

I keep a line KVO if I'm going to hang another bag with in two hours during the day or within three hours at night. I find alot of times at night that the pt. would rather be KVO 'cause they don't want to be too disturbed with the flushing. I don't know why, but they don't seem to mind sleeping hooked up to the pump.

[anonymurse]

A lot depends on the value I attach to having a reliable site instantly available (depends on pt instability), plus how hard it is to get a line on that pt, vs. pt convenience (mobility). Also the more times you screw a luer lock on or off the INT, the looser it may get. Considering the magnitude of risk for infection involved in putting a hole in a pt's skin that goes directly into the bloodstream, I personally don't worry too much about the finer points of "infection rate of frequently accessed ports vs. closed system of IV tubing with piggybacks" although it would be interesting to know.

[anonymurse]

Depends.

How important is it to know for sure you have instant reliable IV access? This depends on the pt's stability.

How often do you have to access the port? Screwing luer locks on and off an INT may make the site unstable.

Is the pt stable, ambulatory/self-care and OOB a lot?

How hard is it to get a new site on this pt?

Does the pt pull on his lines?

The question of "infection rate of frequently accessed ports vs. closed system of IV tubing with piggybacks" would seem infection-wise to take a back seat to the issue of the risk of losing the site and having to punch a new hole in a pt that goes clear through into his bloodstream, though it would be interesting to know.

[luvpeplrn]

We don't keep an IV going at KVO unless it is specifically ordered by the Doctor. We just hang the ABX and flush directly after. I don't know of anyone in my facility that does this...very interesting.

[BriBriRN]

A lot depends on the value I attach to having a reliable site instantly available (depends on pt instability), plus how hard it is to get a line on that pt, vs. pt convenience (mobility). Also the more times you screw a luer lock on or off the INT, the looser it may get. Considering the magnitude of risk for infection involved in putting a hole in a pt's skin that goes directly into the bloodstream, I personally don't worry too much about the finer points of "infection rate of frequently accessed ports vs. closed system of IV tubing with piggybacks" although it would be interesting to know.

You can always change the lock if it get loose......

[shmoofins]

What do you do when the patient has a saline lock with no IV fluids ordered but has 2 or more IV antibiotics? Do you just use different lines for each one and flush the saline lock between each med or do you hang normal saline as a primary to flush the line after the med? Or something different? Somebody told me to set the antibiotic as the primary and use a normal saline 10 cc flush syringe as the secondary and have it flush the line. How is that different from hanging a bag of normal saline on the primary and having it switch over to flush the line after the secondary's done, then disconnecting the tubing once it's flushed? What's the correct way to do it? I'm so confused!

[tiij]

5ml/hr (2ml/hr for neonates) of 0.9%naCl to keep the vein open is pretty standard in my workpplace. i guess it doesnt really matter in the end, just alot easier for us and the patient in the end.

[StephanieScott]

I like the idea of a flush bag. It is more cost effective. At the facility I work at we were thinking of writing a policy about this. I've actually been looking for an example policy that I could possibly tweak. Anybody have one at their facility?

[iluvivt, BSN, RN]

Yes!.... you can certainly can set up a flush bag of NS and then piggyback your abx and other IV meds but it is NOT manadatory or necessarily better than using any locked VAD. You should take into account that this may restict the patient's mobility a bit so I generally prefer to just use the locked VAD. If you are using a locked VAD (ie PIV, PICC or other CVC) you would use primary intermittent tubing. On primary intermittent tubing INS recommends every 24 hr tubing change but CDC has no current recommendation.INS has the rational that b/c they are connected and disconnected (as one would except as opposed to just being hooked up once ) the risk for infection is greater. So there is the risk,so if your hospital does NOT have a tubing change recommdation on primary intermittents that is every 24 hrs or at least every 48 hrs Iwould venture to say a flush bag would be be better in terms of lowering the infection risk.

While a KVO rate can keep a CVC open a good flush now and again is advised especially with things that can build up such as Lipids and other fat based medications. Remember, to really scrub your needleless connectors (caps) per your policy for 10-15 secs and make sure they are changed per your policy and at least every 7 days at max.On studies they have found biofilm in the housing of the caps on day 5 and suspect this is a source of infection on long term CVCs,even though the studies are limited on the long term CVCs of all types.