Right Management and Flushing

Abstract

Peripheral and central vascular access devices are a fundamental and essential part of healthcare delivery, used extensively in hospital and community settings to meet the challenging and complex IV therapy requirements of the modern-day patient. For vascular access devices (VAD) to be a safe and effective tool for the administration of IV therapy, they must be reliable. Reliability in this context refers to optimal catheter function, demonstrated by the ease of flushing and aspirating, combined with an absence of associated complications. Proficient care and maintenance of these devices by healthcare professionals requires a high degree of knowledge, skill and understanding. In this section, we explore the details of flushing by examining how, why, when and with what solution vascular devices are to be flushed.

Flushing in Intravenous Catheters

“…After infusion, the procedure "cleans" the infused drug from the catheter lumen, reducing the risk of contact between incompatible drugs, and removes the proteins in the catheter wall, thus preventing obstruction of long catheters. [1][2][3]6 The lack of compliance with good practice guidelines for catheter maintenance identified in the results of this study is corroborated by international studies. [21][22][23][24][25] In the case of PIVCs, an investigation with 76 Brazilian and Portuguese nurses evaluated the flushing procedure through an online questionnaire.…”

“…The application of laminar flow, in turn, is performed with the administration of a continuous flow of the solution for washing the catheter. 1,2 Studies indicate that flushing with a pulsatile flow significantly reduces fibrin and other deposits compared to laminar flow; it is more efficient in removing fibrin and drug cement and, consequently, preventing catheter occlusion. 1,25 Also, one study demonstrated that pulsatile flow is at least twice as effective in reducing the number of colony-forming units per milliliter compared to a single 10-mL bolus.…”

“…Data collection took place through the systematic observation of the flushing procedure using a structured checklist created by the authors based on INS and ANVISA guidelines, as well as evidence from the literature on the subject. [1][2][3]6 The observation checklist was divided into 4 sections: (1) identification of the observation: date, time, unit, observer, participant code; (2) flushing preparation: preparation bottle, solution, and syringe diameter used; (3) characterization of intravenous therapy: type of infusion, number of items administered, manipulated vascular access device; and (4) flushing procedure: patency assessment, time of performance (before, during, and after drug administration), volume administered, and technique used in the procedure (see Supplemental Appendix A; http://links. lww.com/JIN/A109).…”

“…Flushing is the manual injection of 0.9% sodium chloride to remove fluids, drugs, blood, blood products, and nutrients from intravenous catheters into the bloodstream and to check patency/vascular access device functioning. [1][2][3][4][5] This procedure aims to prevent the formation of thrombi and fibrin, avoid drug incompatibility, ensure the infusion of all the drugs present in the system, and prevent blood return, keeping catheters patent for the following infusions. [1][2][3][4][5] In Brazil, good practice guidelines for flushing in the maintenance of intravenous catheters follow the Infusion Nurses Society (INS) and the Brazilian National Health Surveillance Agency (ANVISA) guidelines in order to promote patient safety.…”

“…[1][2][3][4][5] This procedure aims to prevent the formation of thrombi and fibrin, avoid drug incompatibility, ensure the infusion of all the drugs present in the system, and prevent blood return, keeping catheters patent for the following infusions. [1][2][3][4][5] In Brazil, good practice guidelines for flushing in the maintenance of intravenous catheters follow the Infusion Nurses Society (INS) and the Brazilian National Health Surveillance Agency (ANVISA) guidelines in order to promote patient safety. 1,6 When there are failures in applying these practical flushing guidelines, there is a risk of blockage of intravenous catheters.…”