ISPP 2015

Career Opportunities in Pharmacy
SF Nursing | Peripheral IV and Central Line Medication Administration

– Hello and welcome to
Santa Fe, nursing labs. My name is Professor Sandra Milner. In this video we’re going to demonstrate how to flush both a peripheral
IV and a central line. An IV line is flushed before
administration of medication, and at the end of
medication administration. IV lines that are not in
use are typically flushed, once per shift to ensure potency, but you want to follow
your hospital policy. In this video, we will
demonstrate how to flush both at peripheral line
and a central line. At Santa Fe nursing labs, we
use an acronym called SASH, which stands for Saline,
Administer, Saline, and then Heparin. These are general guidelines, that are used for flushing
any type of IV line, either peripheral or central line. I’m going to start by
demonstrating how to flush a peripheral IV line. I have gathered my needed supplies. I have my first saline, I then have my medication to administer, I then have my second saline, because this is a peripheral
IV I do not need heparin. I have my kiroscap is a new one, and then I have my alcohol
swabs to scrub the, needleless connector. When administering
medications to patients, you always want to make sure
you follow the eight rights of medication administration. The first right is the right patient, right drug, right dose,
right time, right route, right reason, right documentation and right response. I’m gonna wash my hands. I’m gonna put on my gloves. I have checked my medication, I have explained to my
patient what I am doing. I’m following all my eight rights of medication administration. I do not see any redness
or signs of infiltration. So I’m going to remove my old Kiro cap, that can be discarded in the trash. Before I clean the port
I’m going to make sure I do not have any air in my first saline. That will check my med is good. Make sure my second
saline, looks good, okay. My IV is clamped at the
moment, gonna scrub the hub, for 15 seconds. Is important to have a
watch with the second hand when administering IV push medications. Use my first saline. Gonna unclamp my line and
flush with the first five mls. Observe the IV side and not
see any redness or irritation. Doing a slow push, because peripheral IV is in a smaller vessel. Without touching the end
of the needleless cannula, I’m gonna switch my syringes. And I will now administer my medication, at the recommended rate. I’m giving one ml over one minute. You do need to watch with a second hand. I’ll remove my medication syringe, and then need to flush the medication through the rest of the IV. The first ml of this flush, needs to be given at the
same rate as my medication. So I just flushed, one ml over one minute. So this first ml needs
to go over one minute. The rest of the five
mls can go at any rate. I’m using a slow push,
with a peripheral IV in order to avoid damaging
the smaller vessels. As I’m flushing in the remaining one ml, I need to clamp my line to
provide positive pressure, ’cause this is a negative
displacement valve. I will then replace with a new kiros cap. So next I’m going to demonstrate
how to flush and administer a medication through a central line. I have gathered all of my supplies. We have our first saline flush. We then have our medication. We have a second saline flush,
and our heparin syringe. We have kiro caps to
replace and alcohol swaps. I’m now going to go
ahead and wash my hands. I have explained to my patient what medication I have for them. I have double check my drug guides, I’m following all of my eight rights of medication administration. I’m going to check to make
sure each of my syringes does not have air in them, do not have any air bubbles. My medication is still the correct amount. My second saline, and then my heparin. You will either be flushing with, 100 units to one ml of heparin, or 10 units to one ml. It’s very important to
know which type of heparin that you need to use. The 100 units to one ml is
typically in a yellow syringe, the 10 units to one ml is
typically in a blue syringe. It is considered a high alert medication. As you can see I only have 10 ml, size syringes, it is important to use a larger 10 ml or larger syringe on a central line. If you use a smaller syringe
or if you push too much force when flushing a central line, you can actually put so much pressure that you rupture the lumen
and your rupture the line. Okay. I’m going to go ahead and, check, the site, to make sure everything looks good. I don’t see any redness or
drainage around the site. I’m also going to pick
which lumen to use to flush. This patient has a triple lumen. When you have a triple lumen
then you typically have the three ports. You’ll have the proximal port, where that lumen ends closest to you. So it’s three separate lumens the three never mix. So you can put three different
incompatible medications into each line. So the proximal one
which is closest to me, we usually use that for proximal pull, that’s usually where you
pull your blood from, or you do your blood draws. The medial, which is the
port that ends in the middle, that one needle is usually
used for medications. The distal, is the port that ends for the stomach catheter, so closest to the patient’s heart. That one is usually used for diet. So that’s where you typically
administering your TPN. That’s just a general rule, it doesn’t mean that’s the
only port that you can use to administer TPN, pull blood or administer medication. Okay, so you’ll want to
identify which is your, proximal port medial and distal since this is a triple lumen, and it’s written on the
actual lumen and catheter, so this is the proximal. This one is distal. And this next one, says
middle from medial. It also tells you the priming volume, and the size of the catheter, so you know how much to flush. I am going to use the medial lumen, and I am then gonna,
scrub my hub with alcohol for 15 seconds. Now that I’ve scrubbed the
end of the needleless cannula, I do not want to touch it. So I’m gonna get my first saline, I am going to attach it. Before you flush a central line, you want to check for blood return, this checks for a patency. If you do not get blood return, you want to follow standard protocols, for clearing the line before use. I’m going to draw back
my blood, to make sure, and I only want to draw
back into the catheter. I do not want to contaminate
my whole syringe, I do get a blood return. So now I’m going to go
ahead and flush my five mls. For a central line, we typically
use a push, pause, method in order to clear the line especially since I withdrew blood into it. I’ll then administer my medication. So I am giving a push IV medication. If you were giving an
IV medication through the line as a primary or secondary, this is the point where you
would attach your IV tubing. I’m giving my one ml of
medication over one minute, and then going to use, my second saline to flush my
medication through the line. This lumen has a priming volume of 0.6 ml. So flushing the first
one ml over one minute will be appropriate, to clear the line. The remaining four mls, I’m going to use a push pause method, just to clear the line. This type of central line,
does require a heparin lock, of three mls. It is a negative pressure valve, so I do need a clamp as I am, flushing the remaining one ml of heparin. And so I clamped my line, I’m now going to replace my kiras cap and, that completes my administration. Remember, procedures
for performing scanning and documenting your IV, may vary based on the hospital. Always follow hospital policy and CDC infection control guidelines. Thank you for joining us, and remember to check out
other Santa Fe nursing videos. See you next time.

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