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 am a hospice nurse, and understand the confusion about usage of the sub-q "buttons." Some local hospices use them, but we do not, and for a reason that I don't see stated here. When buttons are used for one medication and not flushed between, each time you inject the med, the patient gets the "old" dose that has been sitting in the tubing. My problem with this is that *I* am then injecting my patient with, (and taking responsibility for,) a medication that *someone else* has drawn up and injected before me. Yes, it *should* be the same med, the same dose...but I am taking the last RN's word on what's in the tubing. Sorry, I am not willing to stake my license on that... Flushing the line clear after injecting is a dosage problem for the next dose, and can be a volume problem (remember, it's sub-q) depending on the length of the butterfly tubing...
flushing is basic, nurses need to do it. If the med was sitting in the line, you wouldn't have given it, the nurse following you would have given it.
Have you ever noticed those fantastically confusing hard-to-read compatibilites posters on the back of your med room door? Um, the purpose of that whole thing it to warn you about certain meds that should NEVER EVER be in the line at the same time, because if they mix, they can form crystals, etc, etc, which can be a very serious complication.
Not flushing is lazy. Just do it, it doesn't take that long, and do what you know and were taught, instead of what the nurse from XYZ nursing school does to save time. If in doubt with what you are being taught, consult a "Fundamentals in Nursing Practice" text or your state's nursing practice act. It is your license on the line, not whose skills you are observing.
Where I am we have strict rules that a seperate "button" is used for each medication. We get quite a few hospice patients and I have seen some with 5 or 6 buttons. The tubing is primed before insertion and we don't flush after each dose. The thinking is that each dose is putting enough fluid into the sub-q tissue without adding a couple of mL more. I'm not saying our way is best, this is just how we do it.
Could you get the manufactuers number of the port you are using and have your local rep send you some information on it.. they even do inservices on every product to train and teach the staff the proper way to use an item. Its hard to argue against flushing if the manufactuer says you must flush in order for this port to work properly.
I am a hospice nurse, and understand the confusion about usage of the sub-q "buttons." Some local hospices use them, but we do not, and for a reason that I don't see stated here. When buttons are used for one medication and not flushed between, each time you inject the med, the patient gets the "old" dose that has been sitting in the tubing. My problem with this is that *I* am then injecting my patient with, (and taking responsibility for,) a medication that *someone else* has drawn up and injected before me. Yes, it *should* be the same med, the same dose...but I am taking the last RN's word on what's in the tubing. Sorry, I am not willing to stake my license on that... Flushing the line clear after injecting is a dosage problem for the next dose, and can be a volume problem (remember, it's sub-q) depending on the length of the butterfly tubing...
What do you use instead? At our facility, 2 nurses sign off on any narcotic drawn up. Also, the only meds we have given sq (that I have experienced) are dilaudid, morphine, decadron, haldol, and ativan. I'm not so worried about compatibility problems, but you are right that there is a risk that the nurse before me could have drawn up the wrong medicine. It's low, but it's there, nonetheless. As far as I know, it's never been discovered to be a problem, though.
Could you get the manufactuers number of the port you are using and have your local rep send you some information on it.. they even do inservices on every product to train and teach the staff the proper way to use an item. Its hard to argue against flushing if the manufactuer says you must flush in order for this port to work properly.
Except that the manufacturer of our sets, at least, do NOT recommend flushing. It is also against our policy and procedure.
flushing is basic, nurses need to do it. If the med was sitting in the line, you wouldn't have given it, the nurse following you would have given it.
Have you ever noticed those fantastically confusing hard-to-read compatibilites posters on the back of your med room door? Um, the purpose of that whole thing it to warn you about certain meds that should NEVER EVER be in the line at the same time, because if they mix, they can form crystals, etc, etc, which can be a very serious complication.
Not flushing is lazy. Just do it, it doesn't take that long, and do what you know and were taught, instead of what the nurse from XYZ nursing school does to save time. If in doubt with what you are being taught, consult a "Fundamentals in Nursing Practice" text or your state's nursing practice act. It is your license on the line, not whose skills you are observing.
I have a fundamentals book and I don't recall ever reading about subcutaneous buttons. It's not like they are used in hospitals and nursing homes. It's not lazy not to flush a button. It's recommended procedure from the manufacturer due to the nature of where you are pushing the medicine.
Subcutaneous needles our policy says not to flush. If you have a separate needle for each medication (ex: 1 for morphine, one for ativan), and start by priming with the specified dose, then you are just pushing in the med and keeping the tubing primed. If you were to flush a subcutaneous needle, then you would end up with fluid collection at the site (like an IV infiltrate). If you mean port on the other hand, then all of our Port recommendations are to flush with either saline or heparin, based on the type of central access device.
absolutely you are right in flushing your ports or other lines. It is laziness not to do so and invites all sorts of problems like the lines clotting off or two incompatible meds mixing in the line. I've been an oncology nurse for 7 years and so use a lot of lines and ports and flushing is protocol. Good for you!:anpom:
Please flush the line. You have done the right thing. I am dealing with central lines in my area and we always flush the line after every medication, we follow SASH, saline-antibiotics/meds-saline-then heparin locked if you're not going to use the line after giving your IV medication.
We recently underwent this discussion at our facility. We updated our Policy and Procedures to reflect this. In general some nurses were pushing morphine either through a sub Q port, or Hep lock, slowly over a mg a minute, then doing a straight push of 5 ML NACL. Our reasonsing for updating the P&P was if the morphine is being pushed slow, who know how much was left in the port, or hep lock, and then a rapid flush would push any MS left in quickly.
We tend to practice on the extremely safe side here. But without getting off task, by all means I think you should be flushing with 5 ML NACL following the administration of morphine to assure the resident is getting the correct dosage.
I was wondering how some of you actually push a dose of IVP Morphine. I worked in actue care for a bit, and seen numerous nurses just simply attach, and push the entire dose of morphine.
I insist on my staff always pushing a mg of MSO4 over a minute.
Flushing the line clear after injecting is a dosage problem for the next dose, and can be a volume problem (remember, it's sub-q) depending on the length of the butterfly tubing...
stonette
3 Posts
I am a hospice nurse, and understand the confusion about usage of the sub-q "buttons." Some local hospices use them, but we do not, and for a reason that I don't see stated here. When buttons are used for one medication and not flushed between, each time you inject the med, the patient gets the "old" dose that has been sitting in the tubing. My problem with this is that *I* am then injecting my patient with, (and taking responsibility for,) a medication that *someone else* has drawn up and injected before me. Yes, it *should* be the same med, the same dose...but I am taking the last RN's word on what's in the tubing. Sorry, I am not willing to stake my license on that...
Flushing the line clear after injecting is a dosage problem for the next dose, and can be a volume problem (remember, it's sub-q) depending on the length of the butterfly tubing...