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!
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.
We do prime the line with the medication first, and then leave the line primed for the next dose. As we do not mix the drugs within the lines we can do this. For example, if I am giving 2 mg of dilaudid from a 2 mg/ml vial and I need 0.33 ml to prime the line (we use needless lines that are inserted unprimed and this is the length of the line we use) I insert the butterfly, secure it to the skin the inject 0.33 ml into the line and then the 1 ml for the dose. The next time I use that line I would just give 1 ml as the line already has the 0.33 ml of dilaudid in the line. Obviously this would not work if I was then to give the 4 mg of dexamethasone in the same line or if I was to use a different strength of dilaudid as what is primed would be injected first and the patient would not get the correct dose, which is why we mark each line with medication and dose.
Specializes in LTC, home health, critical care, pulmonary nursing.
We do prime the line with the medication first, and then leave the line primed for the next dose. As we do not mix the drugs within the lines we can do this. For example, if I am giving 2 mg of dilaudid from a 2 mg/ml vial and I need 0.33 ml to prime the line (we use needless lines that are inserted unprimed and this is the length of the line we use) I insert the butterfly, secure it to the skin the inject 0.33 ml into the line and then the 1 ml for the dose. The next time I use that line I would just give 1 ml as the line already has the 0.33 ml of dilaudid in the line. Obviously this would not work if I was then to give the 4 mg of dexamethasone in the same line or if I was to use a different strength of dilaudid as what is primed would be injected first and the patient would not get the correct dose, which is why we mark each line with medication and dose.
Okay...that makes sense. And whoever said look at our P & P manual...it's totally silent on this. I think if we're giving 2+ drugs and are going to use the same site, flushing is in order...what can I say, I'm just a dirty flusher.
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.
If the tubing is primed with the DRUG you are administering and is used for ONLY that drug then do not flush. If the site is used for different medications then you must flush.
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We do prime the line with the medication first, and then leave the line primed for the next dose. As we do not mix the drugs within the lines we can do this. For example, if I am giving 2 mg of dilaudid from a 2 mg/ml vial and I need 0.33 ml to prime the line (we use needless lines that are inserted unprimed and this is the length of the line we use) I insert the butterfly, secure it to the skin the inject 0.33 ml into the line and then the 1 ml for the dose. The next time I use that line I would just give 1 ml as the line already has the 0.33 ml of dilaudid in the line. Obviously this would not work if I was then to give the 4 mg of dexamethasone in the same line or if I was to use a different strength of dilaudid as what is primed would be injected first and the patient would not get the correct dose, which is why we mark each line with medication and dose.
This is how we did it at one facility I was at as a student. The upside is that you're minimizing the amount injected at each site. The downside is the potential for error if someone is not familiar with the system. They may inject the wrong drug, may flush and double dose the pt, etc. I prefer flushing each time as then you know the line is clear. I've worked with palliative pts for over ten years and rarely had any pain issues with this method. If someone is sensitive you just inject the med and the flush very slowly and it's usually tolerable. Localized reactions to drugs ranging from dilaudid to versed are rare in my experience as long as your rotate the site every two to three days.
Everyone made sense with their posts. And whatever you do OP, you and your colleagues NEED to get on the same page with facility protocol and like you mentioned, have one written out.
This is not a case, where one person organizes differently, or has a different method to their madness, that would be okay.This, this is actually a case, where all these differing opinions take place on the PATIENT. That's not too good.
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.
My bad . We call them subcutaneous access ports ( otherwise known as medi-ports) in my neck of the woods. Some of the SCAPs actually do get placed in the arm or thigh which led to my confusion.
Not quite sure what the kudos was for but whatever.
melsch
68 Posts
We do prime the line with the medication first, and then leave the line primed for the next dose. As we do not mix the drugs within the lines we can do this. For example, if I am giving 2 mg of dilaudid from a 2 mg/ml vial and I need 0.33 ml to prime the line (we use needless lines that are inserted unprimed and this is the length of the line we use) I insert the butterfly, secure it to the skin the inject 0.33 ml into the line and then the 1 ml for the dose. The next time I use that line I would just give 1 ml as the line already has the 0.33 ml of dilaudid in the line. Obviously this would not work if I was then to give the 4 mg of dexamethasone in the same line or if I was to use a different strength of dilaudid as what is primed would be injected first and the patient would not get the correct dose, which is why we mark each line with medication and dose.