Saline flush without a physician order?

Gold_SJ · Aug 13, 2011

Well nurse initiation via a policy/procedure (for standing orders) is perfectly fine as it's approved by the medical officers and the facility. If it's a standing order it's fine to do that. Why you need to find out what your facility says about saline flushes, and also what standing orders exist for your floor. We're not saying to initiate what you think best if a standing order doesn't exist.

So for me, we have per standing order the ability to initiate as many flushes as we'd like as it's best practice as well.

We have standing orders for: Ibruprofen, salbutamol, saline, paracetamol/codeine, oxygen, IVT of up to 250mls normal saline and emla/angel cream.

Your floor may have a whole range of different ones.

xtxrn, ASN, RN · Aug 13, 2011

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.

A bolus isn't generally ordered via 3-5 cc syringe....maybe for a gerbil... :eek:

Having fun tonight?

~Mi Vida Loca~RN, ASN, RN · Aug 13, 2011

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.

Well I am assuming, they are assuming, we have common sense enough not to do that. I believe it's protocol is once per shift minimum or at our discretion if we do more. It needs to be done at least once though. The more realistic scenario is I will flush when I come onto my shift, I worry, so I might flush it mid shift or end shift too (12 hr shift) just to make sure all is OK with the IV if it's not being used at all. I will flush before and after a push med if I am giving meds through it but if I am then I won't be flushing it the other times I normally would if it wasn't being used.

stephenfnielsen · Aug 13, 2011

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...

I'm all for order sets, which contain myriad protocols and parameters which state if a then b and if x then z... but the order set must first be implemented by a physician right? Aside from something such as ACLS I would assume that to be true.

Gold_SJ · Aug 13, 2011

Maybe where you work your system is different, for my facility a standing order can be initiated by the nurse at their disgression. Eg. Child has a temperature of 40.3 degrees and is uncomfortable, miserable. I could then initiate paracetamol (tylenol) at 15mg/kg to help bring the temperature down for comfort. I certainly don't have to ring a doctor to get approval that's what the standing order is for, to stop all the extra time wasting.

~Mi Vida Loca~RN, ASN, RN · Aug 13, 2011

I will check exactly tomorrow night who initiates the order set for us and if their is a docs name behind it. I want to say it's whatever doc that is "admitting" the patient but I also remember hearing it's something the facility itself has started. But I know it's not something they (the docs)even actually put in. It automatically fires on the orders when the admission happens. I put admitting in quotes because I had a patient admitted my last shift by a doc that had not seen her yet and wasn't going to see her until the morning. Which seemed odd to me but I am a new grad and I don't know how that usually works and stuff yet.

Just to clarify, I am talking about Emergency order sets, so they would be started when you don't have time to wait for a doc. For example, Epi, Narcan, Fluid Bolus when a pressure tanks, and many other ones. We have other order sets as well but those are put in by the docs when they do their orders and their are standard sets they have to include depending on what's going on.

diva rn, BSN, RN · Aug 13, 2011

I'm all for order sets, which contain myriad protocols and parameters which state if a then b and if x then z... but the order set must first be implemented by a physician right? Aside from something such as ACLS I would assume that to be true.

Ok, I give up, how does this mess relate to "can a nurse flush a saline lock" etc.................................................

which was the original question........

the answer, I think you will have found from the experienced nurses who have responded is an overwhelming

YES........

Jeeezzzzzzzz

Wasn't your question answered about 10 times?

~Mi Vida Loca~RN, ASN, RN · Aug 13, 2011

Ok, I give up, how does this mess relate to "can a nurse flush a saline lock" etc.................................................
which was the original question........
the answer, I think you will have found from the experienced nurses who have responded is an overwhelming
YES........
Jeeezzzzzzzz
Wasn't your question answered about 10 times?

Which I should add, if anyone needs an IV flushed, feel free to come to my home. I have an abundance of flushes and alcohol pads. :| I have finally gotten good at remembering to empty my pockets, I keep my flushes in my leg pocket so I forget it a lot.

stephenfnielsen · Aug 13, 2011

Again, it should be written with the saline lock order or your unit should have standing ORDERS...not just policies...
and we are talking saline not dilaudid......

Where we agree:

1)It SHOULD be written with the saline lock

2)The nurse would be covered IF a standing order was in place (a standing order being an entirely different order than a protocol. The former is de facto written by a physician for all patients on a given unit, the latter implemented at the discretion of the physician to be then acted upon by the nurse.

Where we disagree:

Just because a drug is not a narc does not mean it is insignificant (legally speaking at least).

diva rn, BSN, RN · Aug 13, 2011

Where we agree:
1)It SHOULD be written with the saline lock
2)The nurse would be covered IF a standing order was in place (a standing order being an entirely different order than a protocol. The former is de facto written by a physician for all patients on a given unit, the latter implemented at the discretion of the physician to be then acted upon by the nurse.
Where we disagree:
Just because a drug is not a narc does not mean it is insignificant (legally speaking at least).

What gave you the idea we disagree at all? or don't you recognize sarcasm? I was just being facitious.

xtxrn, ASN, RN · Aug 13, 2011

Ok, I give up, how does this mess relate to "can a nurse flush a saline lock" etc.................................................
which was the original question........
the answer, I think you will have found from the experienced nurses who have responded is an overwhelming
YES........
Jeeezzzzzzzz
Wasn't your question answered about 10 times?

Me thinks this is just a way to argue for the sake of arguing Debate team practice or something :)

Gold_SJ · Aug 13, 2011

This thread seems to be more about splicing hairs then the original question put forward.