saline flushes over infusion pump versus manual flush in peds

[choarn]

I'm particularly interested in responses from nurses who work in pediatrics. My hospital uses med infusion pumps to deliver saline flush after medication administration (which is also administered over the infusion pump, of course). Does anyone have any evidence that flushing the PIV manually with saline is any better than using the med infusion pump to administer the saline flush?

[shiccy]

I was confused at first, but ...

What you're saying is that you want to INT / Hep lock an IV post infusion of an antibiotic or something?

I will typically flush with an IVF line of anywhere from 40 - 50ml's. As I INT the IV, I saline flush it. The fluids you give IV ATB are typically Dex based (not all, but ...), and Dex is a breading ground for bacteria...

That being said, after giving a patient a unit of blood and flushing with upwards of 100+ml's of saline with the IV tubing (while waiting for the next unit to arrive), I always *always* have blood left not only in the tubing, but also in the patients IV. When I flush it w/ a syringe? All that blood goes away.

If you think about it, you're flushing at a rate of (for adults and a 18G IV) at 5ml/0.5seconds. If you calculate that out in a ml/hr rate that you could program into an IV pump, you would get approx 600ml/hr. ... If you're using a programmable Alaris pump (the kind that tell big brother what fluid you ran, what speed it went at, if you overrode any alerts on speed of infusions, etc), that goes straight to a person that has to OK it, I'm sure.

Long story short, I do both. ... Now as far as articles .......? I have no clue.

[K+MgSO4, BSN]

Keeping a continuous infusion running and not disconnecting it every-time an QID IVAB is run will reduce the risk of infection but in Peads you are working with kids who wriggle and move and forget a lot faster than adults that they have an IV in. So you are increasing the risk infection risk but reducing the risk of losing the cannula from dislodgement.

Well that is my theory anyhow!

[littleneoRN]

We do all our flushes off the pump. Reason being that while flushing you are continuing to infuse the medication that was still in the tubing and should do so at the appropriate infusion rate, not at a rapid hand flush rate. And we only flush the remaining length of the tubing, not a large volume like previous posters mentioned. Peds patients may not be as sensitive to infusion rates as our NICU babies, but if it was something that required going on a pump over time, then the remainder of the medication probably justifies that too.

[choarn]

thx for the responses but i think i may have not made my question clear enough. i work for a hospital that has 3 main campuses and there are variations in practice amongst all three; in particular, the method used to deliver a flush after IV medication administration. one campus may frequently use positive manual pressure to deliver a flush after medication administration and one campus may frequently use an autosyringe pump to deliver the flush. obviously, the latter is time consuming but my concern is if using positive pressure to flush after IV medication administration off the med infusion pump does not compromise patient safety, it should be done all the time. it would also improve nurse time. unfortunately, the hospital has no policy on flush administration and leaves alot to the nurses' discretion, which annoys me. i have done some research and there is limited data on this practice. i am left to ask my fellow pediatric nurses to see what common practice is being done and do your have a policy on this. i am advocating for consistency between all campuses.

[Redhead28]

How much med does your tubing hold? How big is the patient? Is it a NICU patient or a large, and we have all seen them, 4 year old? Does this really need yet another policy? Has it compromised any of your patients to just flush by hand vs. flush over the pump? Man I would be happy if somebody would just flush them period let alone how...

[iluvivt, BSN, RN]

I need to know if your intention is to loc the device when you are done? ......Are these PIV..Centrals????? and What kind of cap/valve/LAd are you using....positive..negative or neutral..? then I can tell you what the recommendation is

[choarn]

my clinical question is as follows:

does the use of medication infusion pumps to administer flushes versus the manual positive pressure method to administer flushes have an impact on the occlusion or infiltration rate of pivs in the pediatric population?

we use the autosyringe pump and alaris pumps at my hospital. there is no policy that dictates the method we should use and basically, every nurse does their own thing (flush manually or use the pump to administer a flush).

does anyone have any information on the rate of infiltrations or occlusions they have seen between these two methods?

thanks

[WoosahRN, MSN, RN]

I use the pump to do a flush. My only reasoning is that the med still in the tubing will infuse at the same rate. This refers to microtubing (0.8ml volume) that had a syringe med attached to it. It is either 'Y'd into IVF or a seperate attachment to a lumen or PIV. When the med is done I replace the med with a saline flush and hit restore (to get the same rate). The volume of the microtubing isn't large but I figure I can keep the consistency and flush it on the pump. The only time I hand flush is if it was a med that can be pushed over 3-5 min (but I ran it on the pump so I could tend to other things). That said I am usually not disconnecting a line as I work in PICU and they usually tend to have IVF running. Also the majority of my lines are central lines but we do still have PIVs especially if we have a lot of meds and incompatible meds. So to answer your question the preference of manual flushing versus hand flushing has more to do with the med being delivered then the occurance of infiltration. I don't see why a line would infiltrate more due to hand flushing. I always flush all my lines at the beginning of a shift, whether I am using them or not (exception would be inotropes or other sensitive drips), and before I use them so they are getting manually flushed then as well.

[NICURN29]

I do both, honestly. I most often hang a flush on a syringe pump, but there are times that I flush by hand. And there is no rhyme or reason to when.

If you think about it, you're flushing at a rate of (for adults and a 18G IV) at 5ml/0.5seconds. If you calculate that out in a ml/hr rate that you could program into an IV pump, you would get approx 600ml/hr. ...

5 ml/0.5 sec =

1 ml/0.1 sec =

10 ml/1 sec =

600 ml/60 sec =

3600 ml/60 min

3600 ml/hr, not "approx 600ml/hr"

[iluvivt, BSN, RN]

If your intentions are to lock the device off you are much better off to perform a hand flush with a prefilled syringe and how you perform this depends upon the type of needleless connector you are using (negative, positive or neutral). This will decrease your rate of occlusion as one of the goals of a flush to maintain catheter patency. Now if you are going to switch to continuous IVFs and you are just flushing in between to avoid incompatibilities then that is OK. The last time I checked there were only 2 devices that you could use a pump or IV device in place of a manual flush and these are most often seen in home care and the brand you mentioned is not one of them.