I am familiar with hospitals that practice this way, although I
have never done it where I have worked. This would not be for the
purpose of actually diluting anything, but it would be used as fluid
to keep the catheter and vein open in between med doses. The issues
with this are:
1. KVO is not a valid order since there is no patient-specific
rate prescribed. So the physicians will need to prescribe a
rate.
2. Risk of fluid overload
3. Limitations on patient's ability to get out of bed and
ambulate since they will always be connected to an infusion.
This works best for those patients that are still receiving other
infusions and are not to the point of ambulation.
I also know there are other facilities that will use a bag of
fluids, piggyback all meds into it, and then allow the saline to
infuse after each dose has finished, then the nurse disconnects the
patient after the saline has flushed the line. This is acceptable and
would allow the backpriming procedure to be used for multiple
drugs.
I have recently researched this for one of my manufacturing
clients and there are really no standards about using fluids in this
manner. INS standards do not address it. The other option is to not
use this carrier fluid and infuse each drug directly through the
catheter. This means the nurse must be present to disconnect the
tubing immediately when the med is finished. If not, there will be
blood that refluxes into the lumen leading to a lumen occlusion from
clotted blood. So it is a trade-off for nursing time. Also, using this
carrier fluid connected to the catheter with the backpriming process
for multiple drugs would mean the least amount of catheter hub
manipulation, and thus decrease the risk of catheter related
bloodstream infection. Again, no studies to support that idea
either.
Hope this helps, Lynn
At 2:48 PM -0500 9/14/06, Janousek, Patricia wrote:
Hello everyone, I have been asked to check on the practice of hanging a diluent on a patient who has multiple IVABs scheduled frequently (Q 4, Q6 hours etc.). I'd like to know if anyone does this, and if so, is there set criteria, specific solution, rate etc. Also, are there references I could refer to? INS Standards? Thanks so much.
Patty
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--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
