IV saline/hep lock

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Specializes in Trauma/MedSurg.

Sorry..I have so many IV questions..here's another! I feel like IVs are a weak area for me.:banghead:

When your patient has a saline lock, as part of your initial pt. assessment, do you guys check for patency even if the IV is not being used for IV meds? I asked my preceptor if she does his and she said "nah" but I feel like it would only take 2 seconds to check and if for some reason it was needed, it would be nice to know it actually works!

Also, with saline locks, when you go to give an IV push med, you go with your saline flush and med in the syringe, right? Ok, so you flush before you give the med-give med-then flush again, then you clamp, right? Before you initially give the first saline flush, is this line already supposed to be primed? I was thinking about this the other day and I started freaking out because I was thinking "omg..I just pushed all that air that was in the line into the patient" Does this even make sense? The pt. had a saline lock but there was about 4 inches of tubing attachment. I'm sorry if this is confusing but any help would be appreciated...

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Yes, you should assess whether or not the INT is patent.

flush INT, med, flush INT

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Specializes in ICU.

your correct.... usually checking the patency of the line is part of your med administration record, it would read something like NS flush 0700 q 12 hours... or something like that... when you administer a med you make sure it's patent by flushing a little, then give the med at the appropriate rate, then flush the medication in at the appropriate rate also. check your unit policy on the clamping or not...

The line should always be primed if it's attached. if you have any doubt, you can aspirate into a syringe, either empty and discard and re flush or push back in and flush again.

Hope that makes sense, it's a good sign that your asking questions and not just taking a 'brush off' to your questions!!

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Specializes in Trauma/MedSurg.

awesome, that's what I thought too-that you can just aspirate...thank u!

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Specializes in LDRP.

We have a standard on our floor to flush saline locks at twice a day. its not an order, heck, i don't know if its a policy or not, but its what is expected.

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Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
awesome, that's what I thought too-that you can just aspirate...thank u!

Actually this is not always true - many times you can not aspirate. Most peripheral lines should not be drawn from after the first insertion, almost all the rest should not be drawn from after 24 hours. (Of course there will be times you will break this rule, but for most times it stands).

The line is primed when the IV is first inserted (either right away or after a blood draw) and should always be primed. At times it may not be due to someone not clamping the line. In that case you can try to aspirate to pull the air back but if it doesn't work you might need to push the air in. That little air will do nothing other than cause a little pain to the person (sometimes they won't even feel it).

You should always flush first, give the med, then pulsatile flush (kind of a jerky flushing) and clamp the line as you flush - this help insure it is clear throughout.

I always try to assess the line by flushing during assessment, although in many facilities it can be a part of the med order - flush peripheral iv q8hrs and prn. Also watch those on strict fluid precautions (very rare - except for NICU) because even a little bit in a flush (10mls) adds up fast if you are doing it every assessment and every med and every 8 hrs.

Hope this helps.

Pat

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Specializes in Vascular Access.

Your initial assessment for each pt with a line needs to include its patency. That fact that your preceptor is not assessing the line at the beginning of his or her shift is negligent.

Also remember, some meds are incompatible with normal saline (Neupogen and Amphotericin B to name two) so you could not do Saline flush, Drug, then Saline again, but rather, Saline, D5W flush, Drug, D5W flush, and then finish with Saline.

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I have a quick question- in PACU all RNs open the line completely- remove saline lock from the stopcock to give medication. Can't the med be given through the saline lock?

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