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!
I agree with whoever said - 'the nurses who don't flush are probably misinformed'. You should flush even if you are using the SQ route. You are right on with your rationale. Additionally, if it is not flushed with NS and the drug is left in the tubing then the next dose given is not a full dose, as ordered by the MD.
We were told not flush narcotics you do not know how much of a dose you are giving them.It can be really bad if you are giving drugs like dilauded which are in smaller doses like 1mg/ml if you are flushing a 10cc set how much are the getting.
Where I work, the subcutaneous lines hold 0.25 of a mL. We insert a different line for each medication required and in reality all that is required is to give an addition 0.25ml with the first dose to leave the line primed and every dose after that should be accurate.
It is my understanding that flushing saline into subcutaneous tissue only irritates it and is unnecessary anyway....... hence having a line devoted to each medication.
Specializes in ortho, urology, neurosurgery, plastics.
If the patient has S.C. access that is being used for one drug only, then all you need to do is to prime the S.C. on insertion with the drug you are using and then you need not flush thereafter. As well, somewhere within your institution's Policies and Procedures, must be directions on cannula site change periods. (e.g. q72 hrs). Here in Canada (yay Gold Medals) I believe such P & P s are required in all institutions. I cannot see the U.S. being different.
Specializes in Care Coordination, MDS, med-surg, Peds.
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Not sure i am understanding this...you are putting a line in the body- a vein? and NOT PRIMING IT UNTIL it is IN the vein? THEN are priming it with NS or whatever and PUSHING THE air that is in the tube into the vein????? This doean't sound at all safe!!!!! Please correct me if I have misunderstood!
FOLLOW UP---- just read more, and discovered you were talking SC, not IV, sheesh..my bad, but you had me going there!!
As for Iv's, always flush, unless leaving hepran or hep solution in a Porta cath per policy or Dr order. I was taught the SASH system: Saline, Antibiotic(or other med), Saline, Heparin.........
Were I work, Victoria bc, we have well written P & P for use of subcu butterflies. A differrent one is used for each med and they are primed with the particular med so no flushing. as the med is sitting in the subcutaneous tissue and slowly being absorbed by the body I would imagine use of more than one substance at the site would cause irritation. Also flushing with saline would actually be adding saline to the medication in the tissues and could change the effectiveness of the medication.
Initial prime with Saline....then drug then flush. ALWAYS. Our SC sets take 3 mls to flush....Yes, go with your instinct! :).......then when you go in again,,flush, drug, flush......
Also, HWRIGHT......how do you initially prime with a drug? How is the order written....I mean, if the order is for 5 mg morph the patient would only get 2mg as the rest would sit in the tube? Sorry, just dont understand how you could initially prime with a drug?
Initial prime with Saline....then drug then flush. ALWAYS. Our SC sets take 3 mls to flush....Yes, go with your instinct! :).......then when you go in again,,flush, drug, flush......
Also, HWRIGHT......how do you initially prime with a drug? How is the order written....I mean, if the order is for 5 mg morph the patient would only get 2mg as the rest would sit in the tube? Sorry, just dont understand how you could initially prime with a drug?
The tubing is primed before inserting, so there is always .3 ml of the drug in the tubing when you push your medicine. Our policy is to push only 1 ml per set, as it is very uncomfortable to the patient to displace more tissue than that. We never push more than one med in a set, and we never flush. There's no need to when it is used for only one med, and it is far more comfortable for the patient.
"The tubing is primed before inserting, so there is always .3 ml of the drug in the tubing when you push your medicine. Our policy is to push only 1 ml per set, as it is very uncomfortable to the patient to displace more tissue than that. We never push more than one med in a set, and we never flush. There's no need to when it is used for only one med, and it is far more comfortable for the patient."
So....as this reads (to me)....you prime your SC set with the ordered drug? Then push a medicine on top of it ? And whats in the tube when your drug is pushed? There should never be drug left in the tube(thats a dose the patient isnt getting). Something has to push that drug in the primed line through and it shouldnt be another med. Sorry, just trying to understand your method?
Specializes in Med/surg, ER/ED,rehab ,nursing home.
I work in a hospital. There we flush with 10 cc NS BEFORE a medication is given,and BETWEEN medications ( if given at one time) and AFTER the medication in given. We go thru several dozen prefilled 10 CC needless NS syringes per patient. Keeps the lines from getting clogged. This is with PICC's and Ports...
When you use subcutaneous port, you need to prime the tubing with the Medication you will be using, so we do not flush. What I noticed from your posting is - the same port is used to give different meds. This is VERY unsafe as different meds is pushed on the same site ( could be every 30 minutes to an hour - depending on your doctors order)
The ideal way is to use one subcutaneous port for each meds, the site should be labeled and dated. Depending on the type of manufacturer, a subcutaneous port can stay up to 5-7 days and IT MUST BE CHANGED. It should also be changed when you notice that the site has signs and symptoms of infection or infiltration.
With this method, there is no flushing required. This is a SAFETY ISSUE that your work place has to address. THE SUBCUTANEOUS PORT should be use only for one med. If another meds is ordered, another post should be inserted. Hope this helps.
? And whats in the tube when your drug is pushed? There should never be drug left in the tube(thats a dose the patient isnt getting)
. Something has to push that drug in the primed line through and it shouldnt be another med. Sorry, just trying to understand your method? 
york-hamiRNCCRC
2 Posts
I agree with whoever said - 'the nurses who don't flush are probably misinformed'. You should flush even if you are using the SQ route. You are right on with your rationale. Additionally, if it is not flushed with NS and the drug is left in the tubing then the next dose given is not a full dose, as ordered by the MD.