Saline flush without a physician order?

[stephenfnielsen]

Let's say a patient has a saline locked IV. The nurse knows that it is best practice to flush saline locked IVs with saline every 8 hours. Can she do this without a physician order?

[diva rn, BSN, RN]

That should be written as part of the saline lock order when it was given. Our PICU had standing orders for this, I imagine other floors do as well.

[ICUenthusiast]

What's your facilities protocol say? Some even allow you to order heparin flush per protocol for individuals with central lines to prevent clogging provided they don't have HIT or something. I know also I've seen one where you are supposed to flush a PIV by protocol with heparin flush (again for someone w/o HIT) after taking blood from it (if you can draw off it).

[DookieMeisterRN]

It would be best to follow your facilities policies and procedure.

[xtxrn, ASN, RN]

Where I've worked, an order for saline lock means put it in and maintain it- so the order is within the order.... :)

[Gold_SJ]

I'm with the others, follow your facilities policies and procedures.

Here in my facility it is only good practice to flush with NaCl 0.9% for children hourly if not on therapy to keep the vein open and we can nurse initiate this. But this is an accepted procedure here, it may be very different in your own facility.

If you're talking about a PICC or Port lock, then there should be a policy regarding how frequently you are to flush the line. Some types of Ports it can be days, weeks to a month between needing one.

[stephenfnielsen]

Let's say the institution has a policy that the IV is to be flushed q8hr, but there isn't an order for the patient... I like the idea of doing it "per protocol", but remember, nurses can't initiate protocols, a physician must do that. For example, just because an institution has an insulin drip protocol, it can't be acted upon by a nurse until a physician initiates it.

[stephenfnielsen]

Where in the nurse scope of practice can a nurse put saline into a patient's veins without an order? Just because it is best practice, or hospital policy, doesn't mean that it can be done without an order, no?

The hospital might very well have a policy that all patients will receive pain medication commensurate with their pain level, but that doesn't mean a nurse can order what she feels is appropriate pain medication, no?

[~Mi Vida Loca~RN, ASN, RN]

At my facility there is no order to flush and no order for the flushes. We can flush as often as we want and the flushes aren't scanned. Another local facility I was at they had to be scanned and it was part of the orders,.

[~Mi Vida Loca~RN, ASN, RN]

Let's say the institution has a policy that the IV is to be flushed q8hr, but there isn't an order for the patient... I like the idea of doing it "per protocol", but remember, nurses can't initiate protocols, a physician must do that. For example, just because an institution has an insulin drip protocol, it can't be acted upon by a nurse until a physician initiates it.

A lot of places are starting to have Order Sets that are put in when the patient is admitted. We have them now and it allows us to administer a few different drugs, order a CTX or EKG and so on without having to call and get an order. We have all different types of Order Sets now. But every admission that is an adult will have an emergency set ordered with fixed doses and instructions. It's automatically put in under the admitting doctor I think it is.

[stephenfnielsen]

At my facility there is no order to flush and no order for the flushes. We can flush as often as we want and the flushes aren't scanned. Another local facility I was at they had to be scanned and it was part of the orders,.

As often as you want? Say, maybe 25 of them in 5 minutes for a quick 250 ml bolus? That might be taking it to the extreme, but I'm just trying to figure out where flushes end and IV fluid boluses begin.

[diva rn, BSN, RN]

Where in the nurse scope of practice can a nurse put saline into a patient's veins without an order? Just because it is best practice, or hospital policy, doesn't mean that it can be done without an order, no?

The hospital might very well have a policy that all patients will receive pain medication commensurate with their pain level, but that doesn't mean a nurse can order what she feels is appropriate pain medication, no?

Again, it should be written with the saline lock order or your unit should have standing ORDERS...not just policies...which you seem to be rather hung up on....are you a nurse yet?????

If you are, you should know this, if not, RELAX....

This will all be explained and fall into place when you start working....

and we are talking saline not dilaudid......