To flush or not to flush...advice please.

[lovingtheunloved, ASN, RN]

I cannot find a protocol anywhere at work, and googling it has not helped. I work in a SNF. We use a lot of subcutaneous ports for morphine, etc in dying residents. Some nurses flush the tubing with saline after giving the drug, some don't. I always flush, and my rationale is this: If you don't flush, the medication stays in the tubing and the patient doesn't get it. And as is often the case, if multiple drugs are given through the port, for instance, I gave morphine an hour ago and now I'm giving Ativan, if I didn't flush, I'm essentially giving the morphine and the Ativan just sits in the tubing. A couple of nurses have challenged me on this because they were taught not to flush, but like I said, I can't find anything at all in writing, so I'm going with my gut. I wasn't taught anything about SQ ports in school, so I really don't have a frame of reference, other than using the same rationale for this as flushing IV tubing after you push a drug...because otherwise the pt doesn't get the correct dose. Anyone have any resources? If I'm wrong I'd like to know! Thanks!

[dcRn2b]

I am still in nursing school but I can tell you we MUST flush....we flush give med flush give next med flush ect always ending with a flush. Our instructors told us the same rational you just did. good for you for going with your gut!!

[bigjay]

You have to flush if the port tubing is primed with anything besides the drug you are giving. Otherwise as you said you are not actually giving the drug, simply whatever is in the tubing at the time.

I have been in facilities where patients had sc site that were primed with the drugs and would have multiple sites for multiple drugs, eg one for morphine, one for haldol, etc. These sites would always have that specific drug in the tubings so you wouldn't flush after administration.

So if you're not doing the above you need to make sure you're flushing afterwards. If others are not doing this this is a HUGE issue since you could potentially double dose the patient if you flush. Your facility should have a policy on this so you should find it and refer your co-workers to it.

[lovingtheunloved, ASN, RN]

Yeah, we SHOULD have a policy...I may be the one who ends up writing it. And what's the rationale for leaving any medication in the tubing, period? If I'm giving the second dose of morphine, there shouldn't BE anything in the tubing but saline...because then the patient didn't get the full dose the last time.

[caliotter3]

I go along with you for the reason you stated, it makes sense.

[FlyingScot, RN]

Flush! Bard recommends NS 5ml after medications. Your co-workers who don't flush are, shall we say, misinformed. I'm betting they tell you it isn't necessary to verify needle placement either. Your rationale is correct. I'd also check your facility's P&P book. BTW, I googled your question just for kicks and found quite a few references.

[lovingtheunloved, ASN, RN]

Flush! Bard recommends NS 5ml after medications. Your co-workers who don't flush are, shall we say, misinformed. I'm betting they tell you it isn't necessary to verify needle placement either. Your rationale is correct. I'd also check your facility's P&P book. BTW, I googled your question just for kicks and found quite a few references.

I don't mean a CVAD. I'm talking a needle in the thigh (or wherever) so we don't stick them over and over. The meds are administered via the sq route.

[moonchildLPN82]

I just recently got out of school and we were always taught to flush because like you said some meds can stay in the tubing and also because some meds can break the tubing down faster.

[TangoLima]

I don't know of any specific references, but I would think the rationale you provided would work for IV's, central lines, SQ needles, whatever. The med is staying in the line, and the patient is not getting the full dose no matter how miniscule the amount may be. Also, if you push a different med each time, you may be running into some meds that are not compatible with each other. Yikes!

[lovingtheunloved, ASN, RN]

I don't know of any specific references, but I would think the rationale you provided would work for IV's, central lines, SQ needles, whatever. The med is staying in the line, and the patient is not getting the full dose no matter how miniscule the amount may be. Also, if you push a different med each time, you may be running into some meds that are not compatible with each other. Yikes!

That's what I'm saying!

[melsch]

I am not sure what your policy is, but where I work we use a different sc line for each medication (yes some patients have up to 4 or 5 lines in place, well marked of course) and we do not flush between doses. That way the patient is always getting the correct dose of the correct medication each time the medication is needed. I was always taught that you should rarely give more that 1 to 2 mls in the site at a time and some medications can easily cause a local reaction. I would think that flushing the site or mixing medications would be more likely to cause a reaction or pain at the site, then smaller amounts of only one medication.

[lovingtheunloved, ASN, RN]

I am not sure what your policy is, but where I work we use a different sc line for each medication (yes some patients have up to 4 or 5 lines in place, well marked of course) and we do not flush between doses. That way the patient is always getting the correct dose of the correct medication each time the medication is needed. I was always taught that you should rarely give more that 1 to 2 mls in the site at a time and some medications can easily cause a local reaction. I would think that flushing the site or mixing medications would be more likely to cause a reaction or pain at the site, then smaller amounts of only one medication.

But the patient isn't getting the correct dose if the drug is still in the tubing. As for the flushing, I flush just enough to get the drug out of the tubing. I've never had a patient have an adverse reaction from the volume given through the port. My primary concern is that they are not getting the correct dose if it is not being flushed.