I am in the process of researching the best practice for administering full doses of IV medications. In our organization we have some inconsistencies of whether it is necessary to hang a main line of Normal saline or D5 W if saline is not compatible and administer the medication as a IVPB. Example; our infusion center administers chemotherapy, antibiotics, blood products, and all other types of IV therapy. The Oncology dept uses a main line for every medication to ensure we are giving the full dose of the medication and to ensure safety if the pt were to have an allergic reaction. We have patients get their antibiotic infusions in the outpatient oncology clinic during the week and go to the hospital for IV antibiotics on the weekend. The hospital staff does not use a main line to flush the line with, but Oncology does. So patients end up questioning the difference in the practice.I found one article at http://www.nursingcenter.com titled; "I.V. Rounds; Intermittent I.V. infusions in acute care; Special Considerations" by Karen A. Weeks, RN, CCRN. I wanted to reach out to you for input or to see if you can refer me to any evidence based research article supporting what is best practice. The article that I referred to above states it is recommended to flush the line after the infusion to ensure the full dose is delivered and that no medication is left in the tubing. I appreciate your time and assistance in advance.
Sincerely-
Many people started paying more attention to this detail when we switched from gravity to infusion pumps for all IV meds. You need to assess the fill volume for the pump administration set being used from the point where the med is piggybacked into that pump set to the catheter. This could be as much as 20 to 30 mLs. When the med is admised in 50 mLs, then as much as half of the dose is being discarded if there is no flush solution. I can not quickly recall any specific studies about this but it is simply a matter of looking at the fill volume of the specific sets, figuring out how much drug is being wasted, and making a determination about whether this wasted volume is clinically significant. I would suspect that in most all systems, this wasted amount would be a significant amount and would require saline flushing. Also, if the med is not compatible with saline, you can not allow the D5W to be the only flush. You would need to flush with D5W but then follow with a saline syringe flush. Leaving the dextrose to lock the lumen only provides nutritents for microorganisms, which could contribute to biofilm growth. This is addressed in the flush and lock standard from INS. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861