New nurse advice

[schoolforever]

Hello everyone.

I have found that one of the hardest parts of being a new nurse is how everyone does things differently. It is hard to figure out what I'm supposed to do.

One of the biggest things I struggle with deal with the topic of IV administration. A few questions I have...

1. Say you are administering an incompatible push med through an already infusing line. Is it okay to standby the pump, give 10ml flush, give med, and 10 ml flush? I've seen some people say disconnect from line first, and then others say this could be bad for infection control.

2. Some people say to not use the same IV flush in between administering a push med. If this is something that is true, how do you deal with having so much stuff in your hands without setting anything down (since some say you shouldn't do that either). Can you set flushes down once they are out of the package if capped?

3. I've seen people dilute meds (solumedrol) by giving a few mL of the normal saline flush to patient and then sticking the blunt needle of the *actual* med into the rest of the flush. Is this okay to do?

Any advice would be helpful, even if it's telling me to calm down ?

[Nurse SMS, MSN, RN]

None of these practices are hard stops and you will get varying opinions. I personally never reuse a flush. Pausing an infusion to give a med isn’t wrong and if they aren’t compatible and the patient only has one line of course you have to disconnect for a moment. Scrub it before reconnecting again.

Is the patient safe? Are they protected from potential contamination? Does the practice work for you if the previous two questions are yes, What can you do to mitigate the things concerning you (is bring more flushes, scrub the hub, etc)

[Samm06, BSN, RN]

Typically primary lines should have a separate connector cap where you can push meds and saline flushes through. If not, then yes you need to disconnect the line, flush with saline, push med, and flush with a new saline syringe before reconnecting the line. (Also, if you have to completely disconnect, make sure you stop the infusion first, and then make sure you put a cap on the primary line so you don’t have to get new tubing due to possible contamination).

If you have the saline flushes still capped then you don’t need to worry about contamination. But if you remove the cap, make sure you are actually ready to administer it.

I know what you mean by the solumedrol. The vials my hospital carries already have some saline inside (so it’s already reconstituted correctly) and you just push the topper down to release the saline and then shake gently to mix and then pull up the needed amount of mL in a syringe using a blunt needle and then discard the needle before pushing the med through the IV line.

*having this questioning attitude is a good thing!!!