PCA Pump- is Normal Saline best practice flush?

[GoNightingale, BSN, RN]

Hi folks! I was always told in previous facilities where I have worked (and they have in fact insisted) to use normal saline together with a PCA pump. So I did- I truly never questioned it until last night. Patient on a PCA pump and also had a continuous infusion of D5 1/2 NS 20 Meqs.KChl. This same infusion was used as the flush for the PCA pump. Antibiotics were also being infused into this same line intermittently. Since I was taught to use normal saline, I went ahead and hung the NS using another line (tubing) on a multi=channel pump. A very nice nurse was helping me with this patient and she mentioned that I could have used the D51/2 etc... to flush the PCS pump. I mentioned that it was my understanding that only NS is to be used. She asked the charge nurse and was told that yes, the continuous infusion could have been used ffor the PCA flush.

I'm new to this unit and I think the charge nurse felt as if I was defying her input. This was not my intentioon and not a great way to start on a unit. Besides, there are some unfriendly sorts working with me, that, without even knowing me-would like to see me out of there. Sad...but true.

Could someone out there clarify the normal saline flush information for a PCA pump? I'll tell ya folks, I don't know what I would do without the allnurses.com community.

Thanks a bunch!:redbeathe

[nic09]

I also thought Normal Saline was used as the flush at a KVO rate. The LPN on the shift I work hung an antibiotic through the PCA pump, even though the pt had another lock in the hand, before asking if this was ok. The antibiotic had already infused before she asked, so I asked that she hand the next IVPB through the lock. Not sure if this was correct but I assumed as long as their was a second option for the antibiotic it was safer to use it than to run it through the PCA.

[GoNightingale, BSN, RN]

You're entirely correct about the antibiotic. Thanks for your response nic09!

[RussA, BSN, RN]

On our unit, PCA are run concurrent with IVF. If no IVF been designated, we use NS at KVO rate. If there is an IVF ordered, eg D5 1/2 w/ 20 meq KCL - we use that fluid.

For antibiotics - if the antibioic is compatible with the PCA analgesic, i.e Morphine, and the IVF solution, then it can run as IV piggy-back.

Your method of using NS with PCA, and another available line for IVF and antibiotics is another option.

[pumpkin455]

On my unit, we also use PCA with D51/2NS + 20K all the time...never had an issue.

[classicdame, MSN, EdD]

ALWAYS check for drug compatibility. Call the pharmacist if you have no resources available. One mistake can have horrible results. Dextrose is sugar and sugar makes water thicker and can react to certain meds.

[GoNightingale, BSN, RN]

ALWAYS check for drug compatibility. Call the pharmacist if you have no resources available. One mistake can have horrible results. Dextrose is sugar and sugar makes water thicker and can react to certain meds.

I didn't quite phrase it as good as you, but that is exactly my concern. I was told that PCA narcotics are thick and if not flushed well can plug up the tubing- ultimately not delivering the durg with efficacy. I'm just thinking....ummm..dextrose (as you well stated) and then antibiotics as possible piggibacks when compatible, can't that just stick to the tubing? Your idea about calling pharmacy is well taken.

Thanks everybody for your kind response!

[ChristineN, BSN, RN]

PCA pumps can run with whatever MIVF are ordered, however you may want to double check with pharmacy if your MIVF has K in it. Also, most antibiotics can run concurrently with a PCA.