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?

[rn/writer, RN]

I just don't think it's safe to have a standing order for a saline flush. I mean, what if the patient's sodium shot sky high since flushing before the antibiotic, it could KILL the patient if we just flush willy nilly after the antibiotic too. I just don't think I feel comfortable ever flushing saline without a bedside assessment by the attending MD complete with a dosage and rate before every single flush. This is a safety issue people!!!

Perhaps it would be best to ask the MD to come in and observe you giving the flush, just so you are doing everything the way the doc wants it done. So what if it's 0300. Safety never sleeps! So why should the doc.

[xtxrn, ASN, RN]

It could be prudent to keep the saline flushes in with the controlled substances- one can't be too vigilant with such an unpredictable injectable substance. IDK...maybe it should be limited to PhD-level nurses, who haven't been out of the classroom in years- they would obviously have more knowledge about the potential risks of a product that is obviously a major liability.... Forget the clotted saline locks- we can just keep sticking the patient for every dose- much better than just keeping a perfectly good one patent

But we MUST follow the I.N.S.A.N.I.T.Y. guidelines - very critical :)

[wooh, BSN, RN]

The more I think about it, I'm not sure nurses should be allowed to inject saline. I remember this one time. I flushed the IV. That patient DIED. And that's not the only patient that has died sometime after receiving a dose of normal saline to flush an IV. You'll think your patient is fine. It can happen YEARS later. One of my coworkers, she flushed an IV with saline almost two decades ago. That patient died last year. It just proves you are never safe from the effects of renegade nurse with normal saline in his or her pocket.

But it's not just renegade nurses. There are care techs at my hospital that are bathing patients with dihydrogen monoxide. And from what I hear, you can now get dihydrogen monoxide over the counter! I've heard that ingesting it into the lungs can cause respiratory failure! When I took my concerns to my manager, she wasn't concerned. She said they've been using it for years. Like that's an excuse! Just because it's been done for years doesn't mean it can't kill someone!!!

[xtxrn, ASN, RN]

The more I think about it, I'm not sure nurses should be allowed to inject saline. I remember this one time. I flushed the IV. That patient DIED. And that's not the only patient that has died sometime after receiving a dose of normal saline to flush an IV. You'll think your patient is fine. It can happen YEARS later. One of my coworkers, she flushed an IV with saline almost two decades ago. That patient died last year. It just proves you are never safe from the effects of renegade nurse with normal saline in his or her pocket.

But it's not just renegade nurses. There are care techs at my hospital that are bathing patients with dihydrogen monoxide. And from what I hear, you can now get dihydrogen monoxide over the counter! I've heard that ingesting it into the lungs can cause respiratory failure! When I took my concerns to my manager, she wasn't concerned. She said they've been using it for years. Like that's an excuse! Just because it's been done for years doesn't mean it can't kill someone!!!

Bwaaahaaahaaaaa:hpygrp: I'm finding problems with having too much dioxide in my apartment. Especially when it has to have some type of seasonal temperature regulation.... the thermal issues alone are concerning :)

[Aurora77]

I can't believe I read the whole thread. Now I'm curious what the point is.

I'm also terrified. You see, I gave morphine IV twice to a pt tonight. The IV was saline locked. I flushed a couple CCs before and after said administration. Do you think I'll still have my job when I go back?? :)

[diva rn, BSN, RN]

I can't believe I read the whole thread. Now I'm curious what the point is.

I'm also terrified. You see, I gave morphine IV twice to a pt tonight. The IV was saline locked. I flushed a couple CCs before and after said administration. Do you think I'll still have my job when I go back?? :)

Sadly, No.

You see, there is now a whole movement brought on through the joint efforts of OSHA, JCAHO, and HIPPA (not HIPAA-this is another agency entirely) the Hospital Inspection of Potientially Poisonous Agents....and Saline is the Chief culprit!

In fact, this agency was started just because of the soaring number of deaths and attributed to saline lock flushes.

THis movement is to route out those indiscriminate nurses who think they can infuse such dangerous agents all WITHOUT a DOCTOR'S ORDERS!!!

I myself, have had a patient die after having a saline flush...it was just terrible...and I just found out about it...you see, I flushed a saline lock back in 1995 on a patient in ICU...and I found out he just expired last week.....he was, wait a minute while I collect myself.....only 92!.... But I am sure the residual effects of the saline caught up with him....I am now waiting to hear from the BON.

What are we going to do?

I suggest we all stop flushing...and now demand that only licensed MD's flush those saline locks...it's just not worth losing your license over:eek:

[ZippyGBR, BSN, RN]

With all IVs, you are expected to maintain the integrity of the line. You use your judgment according to how often the line is flushed, keeping in mind hospital policies. An order for a saline flush is not required. Same with O2 where I work. If we need to give O2 to maintain vitals we do so, no order required.

However, that ( and any legally mandated mechanism for you to administer the medicines / use the medical devices in question) will be incorporated in your policies and procedures and if an authorising Physician is required it will be the Executive Medical Director of the hospital / system or the Medical Head of the service if it's for a administrative sub unit of the organisation...

Throw into the mix the pre-filled flushes which are *not* Medicines but are licenced as Devices ( we have them in the UK ) and a further level of complication is created especially if medical devices legislation does not require a prescription for devices ....

[ZippyGBR, BSN, RN]

Sadly, No.

You see, there is now a whole movement brought on through the joint efforts of OSHA, JCAHO, and HIPPA (not HIPAA-this is another agency entirely) the Hospital Inspection of Potientially Poisonous Agents....and Saline is the Chief culprit!

In fact, this agency was started just because of the soaring number of deaths and attributed to saline lock flushes.

THis movement is to route out those indiscriminate nurses who think they can infuse such dangerous agents all WITHOUT a DOCTOR'S ORDERS!!!

I myself, have had a patient die after having a saline flush...it was just terrible...and I just found out about it...you see, I flushed a saline lock back in 1995 on a patient in ICU...and I found out he just expired last week.....he was, wait a minute while I collect myself.....only 92!.... But I am sure the residual effects of the saline caught up with him....I am now waiting to hear from the BON.

What are we going to do?

I suggest we all stop flushing...and now demand that only licensed MD's flush those saline locks...it's just not worth losing your license over:eek:

don't forget the main component by mass and volume of a flush is dihydrogen monoxide!

[linearthinker, DNP, RN]

Yes, by all means, from now on start a new IV with each drug administration. Just to be safe.

:roll eyes:

[OhioCCRN, MSN, NP]

'' Hello Dr X...yes i know its late... i was just wondering..um... could you possibly give me an order to flush Mrs Y's IV with 10cc Normal Saline?.. uh huh... Ok.. well yes i did graduate from an accredited Nursing School why do you ask????''

[xtxrn, ASN, RN]

Where the heck is the OP? It's almost like common sense acted like a can of Raid on a roach..... :) Oh well- they're resilient, and I'm sure OP will be back at some point :)

OP: it's not the thinking that is a problem. As with ANYTHING else, it's the extremism

[joanna73, BSN, RN]

Our Drs hate being called for anything, day or night. If I called to ask for a saline flush, the Dr would surely ask: "Are you a moron?!" And slam the phone down.