Please help as my clinical instructor won't answer my questions...

[anastasia158]

1. I a student at an LTAC. The facility does not run maintenance fluids. So, IV antibiotics are run as "primaries". Should a separate IV tubing be used for each different antibiotic that is run? How does each IV tubing get labeled? Should they be labeled on the date tag that goes on the tubing or do you just leave the tubing spiked in the empty bag to identify what the tubing is for?

2. Why is flushing an IV PICC lline called "capping"? I understand that we will flush before an IV is started and after but is it also done a minimum of every so many hours?

Thank you for answering these specific questions :)

[Esme12, ASN, BSN, RN]

Thanks all. My facilitty does not hang any IVS other than antibiotics ( no maintenance fluid). So, I now understand why they just leave the empty IV bags hung with the tubing for no more than 72 hours.

I am still wondering about what the difference is between "flushing" a PICC line and "capping" a PICC line. They do no use heparin just normal saline. Thanks!

It's probably just a lingo thing. But to actually know what they mean ask the staff, Flushing means to flush the line between meds and capping usually means to stop infusing IVF and disconnect the line from the "cap" instead of leaving something attached to the cap. I hope that helps. I attached a care instruction sheet that talks about capping and flushing.....

http://www.library.umc.edu/pe-db/PICC%20line%20Care%20Instructions%20for%20family.pdf

[psu_213, BSN, RN]

Speaking of facility policy...at my hospital, it is policy to run all ABX as a secondary. If the person does not have maintenance fluids, then we run NSS at KVO.

[classicdame, MSN, EdD]

Heparin is not recommended for routine flushing, so some facilities are trying to erase that phrase from the lingo. Capping is simply a word to describe the act of placing a sterile cap on the end after you have flushed the line. Clotting is a MAJOR threat to the viability of the line and a PICC line is close to the heart. Flushing appropriately is vital. I recommend checking out Infusion Nurse Society website.

Your real problem is the instructor not responding to questions. I understand that adults do a lot of self-learning and maybe this person wants you to investigate for yourself, but sometimes a quick answer creates a giant leap in your understanding of a concept.

[cherrybreeze, ADN, RN]

We run all antibiotics as a secondary with a carrier fluid, even if they don't have continuous fluids running. This is to ensure that the proper dose is given, and to reduce infection risk. We use the same tubing on multiple antibiotics since even incompatible antibiotics can use the same secondary tubing with a backflush. Using a carrier fluid (primary fluid) allows you to prime the line, flush the line, and flush the secondary without wasting medication, using a primary only will wast at least 15cc, which can be a third of the total dose depending on the volume of your antibiotic. It also allows the system to remain connected for multiple infusions, decreasing the number of tubing manipulations which can contribute to infection.

This sounds exactly the same as what I would do/have done. Primary bag of NS, one secondary tubing that is backflushed for each med. Keeps the system as closed as possible. Also, if two abx need to run fairly close together (let's say, you have a 1400 med that is to run over 60 minutes, and then one that is due at 1600). You can TKO the NS until the next one is due, since it's soon, and that's one less time to unhook and rehook the tubing.