Phantom saline in the ICU

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What we mean is thae bags of saline you use for pressure bags, carrier lines and other misc. uses. Currently we don't have orders or policy to cover the use of this saline although everyone knows that you need a pressure bag for a central line CVP or an art line. Without an order the saline isn't entered into the computer and therefore there is not way to charge for it. We are looking into ways to change this. Do you at your institution have an Critical Care order set that includes standing orders for Saline for pressure bags? Saline for carriers?

Speaking of Saline for carriers... Our usual practice is to run a carrier line with a secondary set used to deliver the multiple antibiotics typical for an ICU patient not to mention K+ & Mg runs and to provide a "push" line. Currently there is no order for this saline so it is not accounted for. In a discussion with one of our directors she wanted proof of "evidenced based practice" that shows a carrier is good practice. Our contention is that it is better to have one line connected to patient that is only broken when hanging a piggyback rather than hanging each piggyback on a seperate line and repeatedly exposing the hub of a central line by frequent connecting and disconnecting of antibiotic lines. Does anyone know of anything written about the use of carriers in the ICU?

What is the practice where you are?

How do you charge for the miscellaneous bags of saline?

Are they included in a standard ICU admission order set?

Thanks in advance for the feedback

Chris and Linda on the nightshift

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Specializes in Critical Care.

Oh fer crapsakes already.

You pull the bag out of the omnicell under the patient's name and they are charged for it, plain and simple. Pressure bag, KVO, whatever...they're charged.

You don't have to run piggybacks with KVO's but we generally do so.

You can rig up lines for each and every IV med, using tubing for every single administration, or do it IVPB.

Go with whatever method your facility dictates. If they want to toss money away on individual tubing for each med, so be it.

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Specializes in CVICU.

We have it on an order set like you mentioned

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Where I work there are charge stickers on the bags of IV fluids.

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Specializes in Critical Care.

Sorry for my rather confusing (confused?) reply but I was thinking about omnicell-type charges being applied to the patient automatically when the item is removed from the omnicell.

If you don't have an omnicell how do you charge patients for supplies? I've used omnicell charge systems, charge stickers, and charge slips---sometimes all in the same facility. If the item is not in the omnicell and automatically charged to the patient when it's used we stamp up a charge slip.

We use stickers for CRRT fluids which are on an open cart.

We don't get separate orders for pressure bag saline, for example, but we pull it out of the omnicell and the patient is charged. Same with the transducer set---you may have an order to check CVP but we don't get an order for the set-up. Things are not "charged" as they are ordered on the computer, they're charged as they're used.

So any system that charges the patient, be it slips, stickers, or automatic omnicell charging, would work.

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Our saline is actually in a big bin in the supply room. Yes they have stickers so they are "charged". The problem is with reimbursement. Since they are considered a "medication" or pharmacy item they are not reimbursed by insurance without a doctor's order. This is the sticky part we are trying to fix. Although it seems logical to us bedside nurses to create the order under a set of ICU admission orders it was the request by our director to show evidence based practice saying that running a carrier for piggybacks was "good practice" that tripped us up. Is anyone aware of any evidence that a carrier line is better than having individual tubing for each antibiotic or piggy back? It seems like a no-brainer to those of us at the bedside but you know how directors can be....

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Dec 2009 issue of Nursing2009 has a lengthy article on IV Infx control. INS recommends that intermittent infusion lines should be changed q24hrs, continuous infusion lines q72hrs. If the cost of the numerous intermittent lines over a 72 hr period exceeds the cost of a bag of NS with primary and secondary tubing, you would have justification.

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We do not use a carrier line for infusions and I have never worked anywhere that did.

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Thank You registeredin06! That is exactly the kind of information I am looking for!

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Specializes in MICU, neuro, orthotrauma.

When there is an order for CVP, the charges are predeterminded and covered under that order.

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Specializes in Med/Surg, Tele, Critical Care.

Ask the pharmacy to put it on the mar so you can scan it? I have seen them put a bag of saline on there specifically labeled "for carrier". And also "for blood". I think it's just a matter of remembering to put it on there rather than just pulling it out when needed. It also depends on how your hospital's system works, I'm talking about a system with an electronic mar and an omnicell.

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Where I work all of our IV bags are on a cart in our med room. We have electronic emar but do not scan them. We actually don't charge them at all. It comes from the storeroom not the pharmacy and I do beleive it all comes out of our ICU floor budget. We have a machine that can deliver numerous iv meds at the same time or intermittantly an "omni" has one set of main tubing and many "secondary" sets for each individual med. We don't directly charge for these either. Will all of the budget cuts here in our area, I am very interested to find out your results and also hear how other facilities charge. It may help us.

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