We are having a discussion regarding flushing before and after giving an IV push med thru a continuous infusion via an access port on the tubing set. It seems there are different practices. Is it necessary to flush with saline before giving the med and then again after giving the med if continuous fluids are infusing? If so, what would be the recommended volume of the flush? For instance, we always use a 10ml pre-filled saline syringe to flush (PIV or CVC)...do you need to flush the whole 10Mls or just enough to flush the med thru the access port.
The answer depends upon many factors. Is/are there any med(s) added to the primary fluid container? Is there documented compatibility between the added med and the push med? Has there been any issues with pump alrams possibly indicating an infusion problem?
You do need to always assess the VAD functionality by flushing to assess for resistance, edema, discomfort and aspriating blood to ensure the catheter remains inside the vein. See INS standards on flushing and locking and administering parenteral fluids and medications. Blood return is included in both standards and is one significant component of your assessment of the insertion site and catheter. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I think I need to explain better ...when giving the med thru the access port on continuous tubing and fluids running thru the line, is it necessary to flush afterwards or will the running fluid flush the med thru? Does some of the med stay within the access port area? Let's say that the med is compatible...we are wondering about some med remaining in the access port area. So, the next time I want to give a med, do I need to worry that there is still residual med in the access port area?
Vickie Teresinski, RN, CRNI
Each brand of needleless connector on the IV set will hold a differing amount. Check with the manufacturer for the brand you are using to determine this volume. It will never be large, usually only a small fraction of a mL, but they di have differences between brands. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn for your responses. You were very helpful.
Vickie Teresinski, RN, CRNI