Very Confused About Flushing IV Lines And Bolus Administration

[Demareseitipota]

We absolute don't have those in my country! Here when we have a patient that is receiving IV fluids from an IV bag we connect this 3way stopcock directly to the IV catheter that the patient has on his arm or hand. You see those 2 cups? One is connected to the IV tube and the other we use for push medications. As I mentioned before, medicines cannot come in contact so why they taught us to flush the line when fluids are running? Here you can see a video I found on Youtube and the guy does the exact same thing but why?? Watch at 02:00, he flushes the line even if fluids did/will run again. 

 

[marienm, RN, CCRN]

Here is another reason why you might flush manually after a bolus medication:  To ensure the bolus medication is delivered at the correct rate.

Example: My patient is receiving NS at 240mL/hour (4mL/minute).  They have an order for IV push (or bolus) of Fentanyl 25mcg.  At my hospital, Fentanyl vials are 100mcg/1mL, so I need to give 0.25mL.  My hospital policy calls for pushing this medication over 2-5 minutes. You may see nurses giving medications like this faster than 2 minutes, but as a student with your instructor watching you, you need to follow hospital policy!  This is how you learn safe practices and good habits.  If I paused the NS infusion, turned the stopcock, injected 0.25mL of Fentanyl into the port, and then re-started the NS infusion, the patient would receive the Fentanyl over about 4 seconds.  This, obviously, is much faster than hospital policy indicates.  If I manually flushed the Fentanyl into the port with a NS flush syringe, I could flush it very slowly and deliver the medication at the appropriate rate.  Then I would re-start the NS infusion.

I am not going to say that one of your instructors is right and the other is wrong.  Both practices are sometimes helpful and sometimes necessary.  As discussed by other commenters, sometimes the compatibility of IV solutions is relevant.  Sometimes the speed of delivery is important.  Sometimes it is simply important to do it the way your instructor wants, although you may adjust your own practices in the future when you are an RN.

[murseman24, MSN, CRNA]

I just want to say I think it's great that you're critically thinking and questioning these practices.

[Leader25, ASN, BSN, RN]

On 9/15/2020 at 1:35 PM, TheUserYouKnowNothingAbout said:

Second, let's say that this incompatible push antibiotic comes into contact with the ringers solution inside the IV tube(again,I don't get how this can happen) They mix. From what you are saying, the speed of blood circulation doesn't allow incompatible meds to do harm. So, the ringers and the antibiotic come in contact inside the tube and seconds later they enter the blood system together/mixed. How can that be a problem? 

Cuando tengas experiencia vas enterder,capito?