I am wondering if any nurses have a guideline or a supported practice at their institutions where either based on the rate of infusion or the volume of infusate, do they not flush the remaining medication in the primary tubing (connected to a flush bag and the venous access device) after the secondary tubing (on which the infusate is hung) empties? We use Alaris Pumps where I work. Also, if only a primary line is used and hung by gravity, when the infusate container empties, do they flush any remaining medication in the tubing into the vein. The concern is the added time of infusing the remaining medication into the patient with low infusion rates of say 125 ml/hr or less. I would appreciate any sources of information or existing practices supported by your institution. Thank you.
For all configurations of administration sets and pumps, you need to estimate the volume remaining in the set from the point of connection for the piggybacked secondary set down to the catheter hub. What percent of the total volume of drug is remaining in the set if flushing is not done? For a direct connection of an intermittent medication on gravity infusion, the percentage remaining in the set without flushing is very small. But for a secondary connected to the pump it would be a very high percent, sometimes as much as 50%. You simply cannot leave this large volume uninfused and inside the set. The pump should be programmed to resume the saline carrier fluid at the same rate as the medication. After all medication has been infusion from the set, your policy could be set to allow a very slow rate to continue, eg. 5 to 10 mls per hour on adults. Or you can disconnect the set from the catheter hub after infusion is finished. Or you could infuse by gravity without the pump. Decisions your applicable committees should make when writing your policy..
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