In the home care setting, patients are often administering intermittent IV medications 2-3 times per day via a PICC line. They are flushing with 0.9% Normal Saline flush before and after the administration of these medications. The current volume of the NS flush we are using is 10 ml before administration and 10 ml after administration of medication. If the medication is given 3 times per day, this can result in the administration of up to 60 ml of NS flush in a 24 hour period. Is there a limit to volume of NS flush that can be safely used in a 24 hour period before and after medication administration? Especially with the concern of the amount of benzyl alcohol. Thank you.
Forum topic
Mon, 05/16/2011 - 16:38
#1
Volume of normal saline flush in 24 hour period
The national standards of practice from INS call for the use of preservative-free sodium chloride from a single-dose system such as a single dose vial or a prefilled syringe. CDC, ISMP, and Joint Commission have all supported prefilled syringes also. Benzyl alcohol is limited to no more than 30 mL of bacteriostatic sodium chloride in a 24 hr period in an adult and should never be used in neonates. The only restriction on preservative free sodium clhoride would be based on the individual patient's condition such as fluid overload, renal faliure, etc. See the INS standards on Flushing and Locking for the references for all of these statements. 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
There are some who have advanced the idea that excessive NS flushing can induce Hypernatremia
I did not know how to respond to the the statement--What say you?
Robbin George RN VA-BC Vascular Access Resource Department Alexandria Hospital Virginia
Robbin George RN VA-BC
Normal saline is frequently infused at 125 to 150 mL per hour. NS has 154 mEq of sodium and 154 mEq of chloride per liter. This is close to normal serum levels and the reason it is called "normal" saline. I suppose it is possible for a cardiac or renal failure patient to have some problems when a large quantity was given as a flush, however I don't think anyone has ever published on a negative outcome pertaining to this. Several years ago at INS I asked this same question to a speaker after a presentation on managing cardiac failure patients. Her response was they used normal saline 10 mL and made no changes. 12 doses X 20 mL = 240 mL in 24 hours. This would be roughly 38 mEq of sodium and 38 mEq of chloride. I doubt this would be a problem for any patient and this would be worse case amount. 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
The flushes at our hospital are preservative free. So there is no concern about the amount of benzyl alcohol a patient is receiving. You may want to talk to your administration about switching to a preservative free saline flush. And I agree with Lynn. Normal Saline is standardly run at 125ml/hr. So, flushing with 60 ml in a 24 hour period is not an issue. Even if someone were on a fluid restriction, this amount would, of course, be included in your I&O, but shouldn't cause a problem unless the patient were to drink 3 or 4 Big Gulps from 7 Eleven. :-)
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
The flushes at our hospital are preservative free. So there is no concern about the amount of benzyl alcohol a patient is receiving. You may want to talk to your administration about switching to a preservative free saline flush. And I agree with Lynn. Normal Saline is standardly run at 125ml/hr. So, flushing with 60 ml in a 24 hour period is not an issue. Even if someone were on a fluid restriction, this amount would, of course, be included in your I&O, but shouldn't cause a problem unless the patient were to drink 3 or 4 Big Gulps from 7 Eleven. :-)
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland