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jean mathews
checking patency before giving med or IV solution

Case scenario: A critical ICU patient has multiple compatible vasoactive drips infusing via one picc port (different meds connected by several stopcocks). ICU RN is concerned of stopping the drips mometarily just to check for patency.

Our policy is changing to state that we need to check patency at least every 8 hours or before giving med or hanging new bag.

Curious what other ICU nurses do.

Thanks in advance for a reply.

J. Mathews PICC RN 

VAT RN
Why would you stop meds,

Why would you stop meds, disconnect and flush a line that is in good working order?

 - Opening the system is just one more chance to introduce pathogens.

 - You will pause drugs on a critical patient. We have all seen what even 1 minute of a beeping pump will do, esp with vasoactive drips.

 - An in-line flush will bolus the meds already already in the line.

 

It makes sense for a new med or infusion. Weren't we all taught to "sandwich" a med or infusion with saline flush....no matter what the line?

 

Martha

lynncrni
I agree with the concerns

I agree with the concerns from Martha's message. There is no need to flush any line that is receiving continuous infusions unless there is a problem such as a pump beeping occlusion alarms or blood refluxing into the line. Will your policy for checking every 8 hours call for disconnection of the tubing on continuous infusions when there is no problem? I would have many issues with that practice and there is no evidence-based need for it. Some vasoactive drugs are strong vesicants. I can see the need to periodically aspirate for a blood return from those lines just to assess continued patency. I do not think that the tubing should ever be disconnected from a continuous infusion though. You can attach a syringe to a needleless connector on the line, and aspirate with the pump turned off for just a few brief seconds. 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

jean mathews
We're still in the process of

We're still in the process of revising our policy so any suggestions will be helpful.  We will not disconnect the tubing to aspirate blood.

I thought it was INS driven that we should be checking patency before med administration. So is this only done if the port is capped? 

To write in a policy to periodically aspirate from a line that has continious infusion will be too vague.

Can anyone share their policy with us in regards to checking patency. 

Thanks,

Jean

lynncrni
It is a standard of practice

It is a standard of practice that there should be a positive blood return before a med is infused. If you are talking about a piggybacked med into a continuous infusion, you should never disconnect the tubing. You can attach a syringe to an injection site on the tubing and aspirate. For an intermittent medication without any continuous infusion, you would attach the syringe directly to the catheter hub and aspirate, then flush to check for resistance, then attach the tubing to infuse the med. 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

jean mathews
So, taking this discussion

So, taking this discussion back to that critical ICU pt with multiple drips per port.  RN needs to hang a new bag of dopamine. Will she need to aspirate from an injection site on the tubing before hanging the drip?

Thanks,

Jean

lynncrni
Hospital policy should

Hospital policy should address this, but in my opinion it would be a good idea with each new fluid container. Dopamine is a vesicant and I am assuming you are talking about infusion through a CVC. If you are talking about a PIV, I would say that site assessment including aspiration would need to be much more often. Aspiration should be done from an injection port on the set, not be taking the line apart. 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

DML RN
I don't.

Hey,Jean-

I would be reluctant to do a patency check just for the sake of checking. Realistic ICU situation: Midaz+Fentanyl+Vasopressin+Dobutamine with Norepi as the drive line running through a PICC that had a fine blood return when all this started,has been recently X-rayed and has a good looking CVP wave form off another lumen. Pumps aren't indicating an occlusion,pt. has a blood pressure,made 50ml of urine last hour,RN is happy.

I would not feel a compelling need to confirm patency in this situation,and can't think of a safe and efficient way to do so anyway without bolusing a bunch of drugs or being off them for too long.

There are,of course,other situations (Peripheral IV's,iffy CVC's,ports,etc) where I would take a different approach,but hope this answers your question.

David

PS email me!

jean mathews
Hi Dave! I can totally

Hi Dave!

I can totally understand the reasoning as you have stated. But, how can I word how often to check for patency in the new policy so that it is consistent throughout the hospital?

Should there be exclusions or state check patency only if......

 

Jean

What is your email?

DML RN
Jean- For email,use

Jean-

For email,use [email protected]

Checked our P&P's last night but couldn't find anything specific to your question.

Tough to balance what's truly necessary with what's actually practical--still thinking on this one for y'all. 

D.

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