IV push

[Jedi of Zen]

When you're pushing an IV med into an existing line, should you only flush if you know for a fact that a medication incompatibility will occur with your existing IV fluid? Or, is it okay and/or good nursing practice to just go ahead and flush regardless (ie, even if there is no incompatibility)?

Also, when you do flush, what is the best reference to check to see how many mL (and with what kind of fluid for that matter, too - NS, sterile water, etc.) you should flush with? ie, Does your facility normally dictate this? The drug book? The MD order itself? It seems like between my lecture notes, textbooks, and drug book, I keep seeing different fluids/amounts to flush with, even for the same meds/dosages. 5 mL, 10 mL, 1 mL, 2-3 mL...etc. lol.

[UM Review RN, ASN, RN]

Always flush first. You really haven't a clue about what was in that line before you came along, so the safest thing to do is flush.

Facility policy will dictate what you flush with and how much of it. Depends on what type of line you're flushing.

A simple reseal (saline lock) will generally get a 3 cc normal saline flush. If it's a central line or a port, you'll use a large gauge syringe and flush with more normal saline, because the lines are longer and because a larger syringe doesn't push so much pressure that it could macerate the line.

Some facilities require an additional heparin flush and they provide a diluted heparin solution just for flushes. Some facilities think heparin can be unsafe and have gone to normal saline only. This is why it's important to check your facility policy.

Hope that helped.

[LaceyRN]

The only IV push med I have given so far was on peds floor and there was certain protocol to follow. We always flush with NS (unless incompatible with med) before and after the IVP. The mls of flush were also a standard protocol depending on the IV site (PIV vs. PICC) of course a PICC we would follow with heparin after the NS flush.

So I guess to answer your question we used the drug books to determine flush compatability and then facility protocol to determine the mls of flush based in IV tubing. :)

Hope this helps.

[Jedi of Zen]

Okay. That does help. Thanks to both of you!!

If anyone else has any other comments, please feel free. Thanks again.

[Jedi of Zen]

Hey guys - I have another question that I'm a little confused on here too. When you're doing a bolus push, do you always need to stop the existing infusion before you do the push? My book says to just pinch the line to do your push, unless you know that an incompatibility exists, and only then to stop the infusion. I guess I'm wondering if this is really how it's done in the real world. ?

[Daytonite, BSN, RN]

the idea of flushing is to clear the iv access line of previously infused material or solutes that may be lurking on the walls on the iv tubing or nooks and crannies of the connectors and ports before and after injections.

when you're pushing an iv med into an existing line, should you only flush if you know for a fact that a medication incompatibility will occur with your existing iv fluid? or, is it okay and/or good nursing practice to just go ahead and flush regardless (ie, even if there is no incompatibility)?

you should always sandwich the iv med between normal saline before and after injecting the iv med. here's why. the iv med may be compatible with the existing iv fluid, but how do you know what previously injected drugs might be lingering in the y-connector or port that you are inserting your delivery device into? it is just good nursing practice and you should develop the habit of sasing (giving saline-the antibiotic, or medication-saline) so you don't have to waste your valuable time even thinking about this kind of problem every time you give an iv push medication.

also, when you do flush, what is the best reference to check to see how many ml (and with what kind of fluid for that matter, too - ns, sterile water, etc.) you should flush with? ie, does your facility normally dictate this? the drug book? the md order itself? it seems like between my lecture notes, textbooks, and drug book, i keep seeing different fluids/amounts to flush with, even for the same meds/dosages. 5 ml, 10 ml, 1 ml, 2-3 ml...etc.

you are

never

going to give sterile water as a direct iv push or as an iv drip into any patient's iv line!

most facilities that i have worked in have policies on what drugs the nurses (and which nurses) can give by iv push and how the iv push is to be done. the facility policy trumps everything including doctor's order,

but

this is something that you will want to clarify when you go through your orientation when you are hired. you can never just dismiss a doctor's order just because it conflicts with a hospital policy. you still have to notify the doctor what is going on.

i still have a printed page of the iv flush policy from the last facility iv team that i worked on and i've typed it at the end of this post. it specified the fluid (saline or heparin, and it's concentration), the amount to use and how frequently to flush.

the device in use and the drug involved must also be taken into consideration. some of these drugs are very irritating and need to be thoroughly flushed through and out of the patient's veins. some of the devices the injections are being given into are very long, as in central catheters, and you need to make sure the drug is being flushed completely out of them and into the patient's circulation.

if there is no facility policy or doctor's order, consult a drug reference. if you cannot find any information, call the doctor and/or get your supervision and management people involved in the problem.

i also have a copy of

2007 intravenous medications

, 23rd edition, by betty l. gahart and adrienne r. nazareno. it is much like a nursing drug reference except that it's focus is only on medications that are given intravenously, many of them by iv drip. iv flush information is included for specific medications where they can be given by iv push.

the intravenous nurses society (ins) publishes the standards of iv therapy. you have to buy it from them. i don't happen to have a copy at this time and, truthfully, i can't remember what their specific policy is on giving iv push drugs and flushing. unfortunately, many facilities do not always adhere to the ins standards in favor of saving money.

normal saline is felt to be the safest solution to use when flushing. the reason drugs react with other iv solutions and precipitate out is often because of the solutes in the solutions. dilantin + d5w will result in a precipitate of fine threads that appear throughout the iv tubing that will clog the lumen of the iv cannula when they finally reach it and cause the iv to stop running. as i understand it, the sodium and chloride in normal saline exist in a 1:1 ratio, are bound to each other and do not break that bond easily. neither does the hydrogen and oxygen of the water which is very stable. so, a chemical reaction between normal saline and the iv drug is highly unlikely. the only drug i can think of that is not compatible with normal saline is amphotericin. the pharmacy, i am sure, would label these drugs very clearly!

______________________________________

iv and central line catheter flush policy xyz hospital

sas - saline - antibiotic (or other medication) - saline

sash - saline - antibiotic (or other medication) - saline - heparin

peripheral iv - flush with 1 cc of normal saline q8h. sas before and after meds.

non-tunneled central (triple lumen catheter) - flush with 2.5 cc of heparin (100 units/cc) daily per each lumen. sash before and after meds.

hickman - flush with 2.5 cc of heparin (100 units/cc) daily. sash before and after meds.

groshong - flush with 5cc's of 0.9% normal saline daily. sas before and after meds.

picc - flush with 2.5 cc of heparin (100 units/cc) daily. sash before and after meds.

groshong picc - flush with 5cc's of 0.9% normal saline daily. sas before and after meds.

implanted port - flush with 2.5 cc of heparin (100 units/cc) daily. sash before and after meds.

[meandragonbrett]

you are never going to give sterile water as a direct iv push or as an iv drip into any patient's iv line!

you wouldn't flush with sterile water, but some meds are mixed with sterile water for reconstitution to be given ivp or gtt.

[al7139, ASN, RN]

OK,

I think what you are asking is if when you are administering an IV medication, do you 1) Flush first, and 2) after, and 3) how much flush to use.

Here's what we do at my hospital:

First and most important, we always use 0.9% saline to flush (most hospitals now have this in pre measured 10ml syringes) before any medication, especially if there are no fluids running and the IV is just "saline locked" or "heparin locked". The reason for this is that if the IV has become compromised in some way (infiltrated, clotted, etc.), then just pushing the med could cause major problems. There are IV meds that can cause necrosis if it leaks out of the vein. So we always flush to ensure the IV is patent. Also you always want to flush after to ensure the patient gets the total dose, and that there is no med left in the catheter, as some meds can congeal or even disintegrate the catheter if left in it. If a patient is getting any fluid other than normal saline, I generally disconnect the fluids to give a med, unless it is an IV piggyback that is OK to give with that fluid (call your pharmacy to ask about compatibility).

After giving the med , you should flush again, and then depending on the type of access, and your hospitals policy follow with the correct dose of Heparin.

Hope this helps.

Amy