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!
Specializes in LTC, home health, critical care, pulmonary nursing.
Carolmaccas66, please read what I wrote again, and you have to understand that a subq disc is NOT an intravenous line. It's not a "push and flush" device. You don't flush saline into subcutaneous tissue. You prime the tubing with the intended medication, and everytime you give a dose (with the same strength per ml dose), you've delivered absorbable medication into the subq tissue which is the intention. And if everyone on your unit or floor is properly educated and trained in the use of subq discs, if you use them regularly and your co-workers are properly trained in their use and intention, then you know what's in it because it will be labeled with the intended medication. But believe me I know where you're going with not being sure who did what with it before you got there. If it's not labeled and not properly primed with the intended medication then you have defeated the purpose of it. It's the responsibility of your education department to make sure everyone is on the same page with their use. If you flush a subq disc, (NOT talking about an implanted mediport), if you flush then your action is detrimental to the patient. It's the equivalent of continuoulsy putting saline into an IV line that you know has infiltrated. It's not good for the tissue, and not only that, the next time you give a med into the subq disc then chances are you may have saline which is not as readily absorbed still sitting in that space. The medication is made to be readily absorbed, straight saline is not. I do understand that there are organizations that do it, per policy. And to put it bluntly, if they don't do it properly, they're wrong and shouldn't use them.
I no longer work for the facility I did at the time I started this thread, and at the time I left, I was STILL trying to get them to write a policy to the effect of what you're saying. Turns out I (and most everyone else) was wrong, which I was TRYING to get them to understand, only it never worked.
As far as saline in the sq tissue, it isn't harmful in small amounts. The reason it is so unpleasant when an IV infiltrates is that the volume going in is too much too fast. Hydration can be given SQ, though it takes FOREVER and usually was just used to appease the family of a dying patient. Not particularly effective, but not harmful either.
Specializes in Neurovascular, Ortho, Community Health.
Just curious as to what types of areas you guys work in that these are used? At first I thought the post was talking about subclavian ports. I've never seen/heard of these.
NurseRivera, I used them in a med/surg setting. Mostly, but not always, when the patient was at the point of comfort care or had become a hospice patient when they are getting frequent morphine, ativan, haldol, etc. Usually a number of times a day so they're excellent for that type of administration after traps and lines have been removed and we're just making the patient comfortable. I got a lot of those patients and that's mostly when I have used them, other people may have different experiences with their use. And true, they're not used in a lot of places and people aren't familiar with them, hence the problem with how they're used because of unfamilarity. My wife has been an RN in ER and ICU for almost thirty years and she had no idea what they were either. They're not used in every area of nursing by far.
lovingtheunloved, ASN, RN
940 Posts
I no longer work for the facility I did at the time I started this thread, and at the time I left, I was STILL trying to get them to write a policy to the effect of what you're saying. Turns out I (and most everyone else) was wrong, which I was TRYING to get them to understand, only it never worked.
As far as saline in the sq tissue, it isn't harmful in small amounts. The reason it is so unpleasant when an IV infiltrates is that the volume going in is too much too fast. Hydration can be given SQ, though it takes FOREVER and usually was just used to appease the family of a dying patient. Not particularly effective, but not harmful either.