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In a hospital, the policy and procedures for flushing all catheters is established through the same process as other p&p. The nurse follows the frequency, volume, concentration, and techniques outlined in this document .  I have never worked in a hospital that required a separate physician's  order for  anything pertaining to catheter flushing. All catheter flushes should be documented in the MAR with the volume, concentration, time, etc noted. This is often a pivotal point in many legal cases I have reviewed. The only thing we have to rely upon is what the nurse states as his/her usual practice because it has been several years and they can not remember actual steps taken in this particular case. Of course, documentation of all steps taken is far better than this type of testimony. Also I teach that catheter flushing is a primary way to assess catheter function, so the choice to give a vesicant med through any line depends upon how if functions when flushed. So don't forget to document the pre-medication flushing either. Lynn