When the IV med is finished running

[*ac*]

(such as abx) and you're not running any maintenance fluids, do you flush, d/c and heploc? I've noticed some people put a flush on the line and then leave it connected, with the pump turned off. Won't the line clot if you do that?

[gonzo1, ASN, RN]

You need to check the policy and procedure with your facility. In my experience you disconnect the (antiobiotic or whatever), and flush the heplock which may or may not have a j-loop on it. At no time would you leave a flush hanging on a line.

If you are using a j-loop set up they usually come with a little slide clip that you slide to close the heplock so it doesn't clot.

Some hospitals don't use j-loops they just put a posi valve on angio cath and that keeps heplock from clotting.

Please check your facilities policy with your nursing supervisor or clinical educator

[MikeyJ, RN]

As long as they have flushed it (whether it be saline or heparin push or flushed it using a pump), it shouldn't clot.

I have noticed that there are a few nurses that will then turn off the pump (after flushing) and not disconnect the IV. I usually ask the nurse if I can disconnect the IV, and nearly 99% of the time they say "oh yes, go ahead.. I was too lazy/busy to disconnect it earlier."

[Virgo_RN, BSN, RN]

I disconnect, flush with NS, close the slide clamp. We use positive pressure caps, but saline locks still clot if not flushed regularly. Also, if the cap becomes disconnected from the extension set, the patient can bleed quite a bit. That's where the slide clamp comes in.

[diveRN]

Even if it's one antibiotic, I always set up a NS rider to which the abx is piggybacked. Even if the pt is fluid compromised, an extra 10 or 20 cc of fluid isn't going to hurt them. We run PIVs at 10cc tko and 20 on central lines per policy). I would rather have them get +/- 20cc of NS than lose one port in a central line or have an IV clot off on a pt who is a difficult stick. Since most of our ICU pts are on IV protonix and some sort of abx, so we often have at least two med infusions to do in 24 hours.

Running a TKO for a 1/2 hour to an hour buys time until you can get back to it and lock it. We keep 100cc NS bags just for this.

[NeosynephRN]

Even if it's one antibiotic, I always set up a NS rider to which the abx is piggybacked. Even if the pt is fluid compromised, an extra 10 or 20 cc of fluid isn't going to hurt them. We run PIVs at 10cc tko and 20 on central lines per policy). I would rather have them get +/- 20cc of NS than lose one port in a central line or have an IV clot off on a pt who is a difficult stick. Since most of our ICU pts are on IV protonix and some sort of abx, so we often have at least two med infusions to do in 24 hours.

Running a TKO for a 1/2 hour to an hour buys time until you can get back to it and lock it. We keep 100cc NS bags just for this.

:yeahthat: I do this too, always! I am in ICU also and you never know what is going to happen to your other patient.. I would much rather be running NS TKO..then loose the line. Once we have access, we do not want to loose it!!

[*ac*]

As long as they have flushed it (whether it be saline or heparin push or flushed it using a pump), it shouldn't clot.

I have noticed that there are a few nurses that will then turn off the pump (after flushing) and not disconnect the IV. I usually ask the nurse if I can disconnect the IV, and nearly 99% of the time they say "oh yes, go ahead.. I was too lazy/busy to disconnect it earlier."

This is what I was trying to describe. If you did leave it like this, would it clot??

[megananne7]

Even if it's one antibiotic, I always set up a NS rider to which the abx is piggybacked. Even if the pt is fluid compromised, an extra 10 or 20 cc of fluid isn't going to hurt them. We run PIVs at 10cc tko and 20 on central lines per policy). I would rather have them get +/- 20cc of NS than lose one port in a central line or have an IV clot off on a pt who is a difficult stick. Since most of our ICU pts are on IV protonix and some sort of abx, so we often have at least two med infusions to do in 24 hours.

Running a TKO for a 1/2 hour to an hour buys time until you can get back to it and lock it. We keep 100cc NS bags just for this.

I also do this. I like to make sure they get all of that ABT and not have some of it sitting in the tubing.

[*ac*]

Even if it's one antibiotic, I always set up a NS rider to which the abx is piggybacked. Even if the pt is fluid compromised, an extra 10 or 20 cc of fluid isn't going to hurt them. We run PIVs at 10cc tko and 20 on central lines per policy). I would rather have them get +/- 20cc of NS than lose one port in a central line or have an IV clot off on a pt who is a difficult stick. Since most of our ICU pts are on IV protonix and some sort of abx, so we often have at least two med infusions to do in 24 hours.

Running a TKO for a 1/2 hour to an hour buys time until you can get back to it and lock it. We keep 100cc NS bags just for this.

A lot of times, with little kids, the abx come in a syringe - we usually use a small portable syringe pump. It's possible, with the correct tubing, to set it up in its own chamber on a regular IV pump, but there's no way (on our pumps) to set up a syringe as a piggyback. I saw that done in a training class, but our floor does not stock the tubing set needed to do it that way.

Soooo, when the syringe is finished, you must go in and manually attach a flush - it can either be put on the syringe pump, the IV pump, or you can manually push the NS through the tubing. When that's done, I go back in and d/c the tubing from the pt, flush with low dose heparin (per protocol) while clamping. Some people don't take this last step, though... and I'm just wondering why it is/isn't necessary.

[RazorbackRN, BSN, RN]

It is our protocol to leave the tubing connected whenever possible to prevent multiple entries into the line, thus reducing cath associated infections. Of course, most of our pt's have RA lines or other forms of central access. This is especially helpful when a pt is having to have multiple replacements and you are reaccessing the line several times a day for the same reason. However, we do run NS w/ hep 1:1 continuously through these lines, so the clotting really isn't a big issue in my area.

[CVICURN2003]

We use cathflo for our central lines and picc lines. Almost all of our pts have one or the other. It is a lifesaver (literally) for central line replacement. Pain in the rear...yes. But much less so than changing the line. I don't know the cost difference between cathflo and central line exchange, but much less trauma to pt and chance of infection IMO.

I have only used the cathflo a handful of times.

We use the J loop with a clamp on a PIV. We haso have clamps on our piccs and CVC. I always try to immediatey dissonnect my infusion and flush with 10 ml h2o. But, if everyone says that with two sick ICU patients you ALWAYS flush immediatly when it finishes...IMO it's kind of like saying, "I could NEVER make a med error"......

I piggyback into fluids when pt's have them running or they are comp with another med hanging. We have CVP lines connected on most of our paitents so I usually pigggy back or push IVP into those and flush and zero appropriatly. And we have to place a dead end cap on all of our piggybacks.

[yeSICU]

:yeahthat: I do this too, always! I am in ICU also and you never know what is going to happen to your other patient.. I would much rather be running NS TKO..then loose the line. Once we have access, we do not want to loose it!!

In the ICU our patients shouldn't be heplocked in the first place... Unless they are waiting for a bed on the floor. Ship em out! lol