Very Confused About Flushing IV Lines And Bolus Administration

[Demareseitipota]

Hello and first of all sorry for my bad English. I am a nurse student in Italy and right now I am on my first year. So, to get to the point quick.. From what I have learned ,we use Saline flashes(3 to 5ml) before and after we administer a  bolus medication via an iv line. The reason for that is to keep the line patent and free from blood clots, medicine, etc. 

Now to get to my question. My(excellent) teacher has told me that you do that ONLY if the patient has a venous catheter without being connected to an iv bag,meaning without taking any iv fluids at the moment.Just a catheter itself on his hand without a bag solution. 

 But.. another teacher taught me to do flushes before and after bolus medicine administration not only to patients I mentioned above,but also to patients that they receiving iv fluids(lets say n/s, or ringers lactated or electrolytes or whatever it doesn't matter). My question is just  WHY. Supposedly, the Saline flushes are used to keep the iv line patent, but if the patient is taking iv fluids this means that his line is, obviously, patent and I can just give the bolus medication without flushing before and after. 

From a little research I did on the internet, I found that you are supposed to flush the iv line before and after bolus medicine administration to patients that are receiving a solution via a bag, just to make sure that INCOMPATABILITY between medicines and the solution won't happen. 

THIS DOESN'T MAKE SENSE AT ALL. Let's say I do what the teacher has taught and what the internet articles advice. 

So for example, I have a patient that right now, is receiving Ringers Lactated iv. 1) I stop the infusion,2) I flush,3) I give the bolus medicine 3)I flush again and 4)I start the infusion again.Did I prevent the possible incompatibility? Of course not!! The medicine and the solution are gonna meet and mix up inside his blood system/inside his veins literally the next second as soon as I let the Ringers solution to run again into his vein. So if the medicine I just gave is incompatible with the solution, incompatability will happen anyways, flushing or not flushing, the medicine will mix up with the solution inside his blood system in seconds. 

This drives me insane cause I don't know what teacher to listen to. Personally, I think that we need to flush iv lines that are not connected to any bag infusion.The reason is to prevent blood clots. 

I find it insane to flush an iv line that is connected to an infusion bag(N/S, dextrose etc it doesn't matter). The patient will not form blood clots, and speaking for incompatibility between medicine and solution.. It will happen inside his blood system flushing or not flushing. 

I hope you all understand what I am saying and again, sorry for my bad English. 

[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?