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JoseDelp
saline flush with start of PIV

We have gone to EMAR.... and are struggling with a dilema. Nursing techs in ciritical care are trained to place peripheral IV cannulas and need to obviously flush the line when it is placed.  Saline is considered a medication and therefore should be scanned prior to administration. Techs do not have access to EMAR. The struggle is .... saline in this setting is it really a med or is it part of a procedure to clear the flashback of blood? What are others doing regarding this problem? Techs accessing EMAR for this or saline for this purpose not required to be scanned into EMAR?

lynncrni
In my opinion, if the tech

In my opinion, if the tech can not do the entire procedure including documentation, they should not be doing any part of it. You can not simply disregard the need for documenting the flush with the saline to provide evidence that this catheter was open and patent when the tech left the patient. There is a huge debate about whether this task can actually be delegated to unlicensed staff. You should check with your state board of nursing for their specific guidance on delegation and determine if you are within the appropriate scope of practice for these techs. Remember, the RN retains the complete responsibility for anything these techs do. 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

JoseDelp
You are right there. The

You are right there. The issue though is not just documentation. Our policy provides that we use saline flush to start the IV but the same saline is now being put on the  Medication administration record as well. I am with you on the role of the tech and the nursing responsibility piece. At this point our State Board and our hospital admin still believe the tech with adequate supervision and training can place peripheral IV cannulas....

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

lynncrni
So it would seem that the

So it would seem that the only issue is the new EMAR and the techs not having access to this document. Is there a procedure sheet that the techs use to document the PIV insertion? If so, can they document the initial saline flush on this sheet instead of the EMAR? As I mentioned, these techs need to be doing the entire procedure which includes documentation. Obviously they can not do the PIV and wait for the nurse to flush the line. Neither should they be inserting, flushing and not documenting the flush. Or your documentation could say "flushed per protocol, good blood return, no signs or symptoms of any complications" and not document the initial flush on the EMAR. The written protocol would provide the details of what was done. Would that work? Or does your pharmacy have an issue with this because they are saying that saline is a drug? I am very interested in how you resolve this so please let us know the outcome. Thanks, 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

JoseDelp
techs and saline flush

The techs are only allowed to flush saline. We do have them charting electronicallly and could modify the insertion form to include flush with saline etc..... Interesting thought .... the EMAR working group may feel that as a medicatin it still needs to be n the EMAR... I will let you know.

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

kmills
Techs and Saline Flush

I agree with Lynn and question the limitations of their practice. When these techs place the IV's are they allowed to connect it to an Intravenous Solution? What if the solution contains medications? Are they allowed to administer medication in any form?

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