I am interested in how institutions are documenting saline flushes related to vascular access device; peripheral and central lines. We have been barcode scanning and documenting on the MAR for several years with our electronic medical record. This pratice is being challenged because of a reference that states normal saline flushes used in this manner are not considered a medication and therefore should not be on the MAR. Is there a reference that clearly states this. If the documentation is not on the MAR how are others assuring the devices are flushed, patency verified with the appropriate amount of fluid and correct interval?
Mary Vassalotti, CNS, APNP
Meriter UnityPoint Health
Madison, WI
Saline is technically a medication and we must have an order to give it. Our docs order "Routine venous access orders - Saline flush per protocol." This also includes documentation of medication administration in the manner (MAR or EMAR) that is routine. I always scanned them.
I have seen many sets of medical records from various hospitals where the saline flush and heparin lock are printed on the MAR once pharmacy has received this information. In hospitals, I have always been told this was a mechanism for ensuring that the flush and lock solution was actually supplied for that patient and that the nurses were using it. In other words a mechanism to ensure nursing compliance with the established hospital policy and procedure. I have always worked where this was addressed in hospital policy and procedure and did not require a specific patient order to use these solutions. I do think it is important to document all fluids given for any patient on fluid restrictions including saline flushes. The issue of saline and hep lock solution may be addressed by your state board of pharmacy, however this may be written in a manner that applies more to home care than hospitals. I have never seen anything stating one way or another about documentation of each and every saline flush. I can not find anything in the INS textbook about documentation for saline flushes. I can also see a need to flush many catheters at times other than after medication infusion. You may need to assess potency during a continuous infusion or when blood has backed up into the set. Problems with flow rate or occlusion alarms call for saline to check the line. To expect each and every drop of saline flush solution to be documented on all patients may be too much for many staff nurses. Saline in prefilled syringes is labeled by the FDA as a combination product - a drug and device together. I think many state pharmacy rules have changed their policies about home care nurses carrying extra prefilled syringes based on this combo product classification. 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