The flushing procedure in nursing practices: A cross-sectional study with Portuguese and Brazilian nurses

Abstract

Background In patients with peripheral intravenous catheters (PIVCs), performing flushing is an essential procedure to maintain catheter patency and prevent complications. These PIVC related complications can lead to premature removal and therapeutics interruption, which implies the need of a new catheterization thus increasing patient discomfort and pain. Aims To identify nursing practices related to the flushing procedure, namely: moment(s) of the flushing; the syringe size used; the flush solution, volume and technique; the knowledge and accomplishment of the recommended standards on flushing by nurses. Methods A cross-sectional study was conducted between July and December 2017, with Brazilian and Portuguese nurses. An online questionnaire was developed based on the international recommendations on flushing procedure. Descriptive analysis was performed. Results A total of 76 nurses answered the questionnaire. The majority of nurses (84.2%) performed flushing: the most common technique used was continuous syringe pressure (31.2%), with the push-pause technique being performed by 23.4% of the nurses. Despite the majority performs flushing at four distinct moments (after the PIVC insertion, before, between and after drug delivery), there are inconsistencies in flush solution, volume, and syringe size. The most used volume to perform flushing was 5 mL, filled using normal saline. Despite this, they also recognized the omission of this procedure due to time constrains, no familiarity with the procedure and unavailable material. Conclusions This study identified that flushing procedure isn't always performed by nurses in their clinical practice. Also, several inconsistencies were observed between nurses that performed flushing, reflecting the lack of empirical evidence in this area of research.

Prǭticas de enfermagem relacionadas ao flushing em cateter venoso perifǸrico: estudo descritivo

“…No presente estudo, a maioria dos profissionais relatou realizar o flushing (89,7%), sendo um aspecto positivo para a prevenção dessa complicação. Esse achado vai de encontro a outro estudo transversal realizado recentemente com profissionais de enfermagem do Brasil e de Portugal, cuja taxa de realização de flushing era 84,2% (13) . Apenas 12,86% dos profissionais de enfermagem afirmaram utilizar a técnica pushpause, técnica indicada para realizar o flushing (5) .…”

“…Na maioria das vezes, essa prática é baseada na política da instituição, na experiência de trabalho pessoal e do colega (2)(3)(11)(12) . De acordo com alguns autores, quando não há padronização no cuidado, os riscos de erros e complicações aumentam consideravelmente (11,13) .…”

Microbial growth and importance of flushing inside closed-type infusion devices during administration of lipid emulsion in vitro setting

“…There are some reports about improper handling of catheters as one of the causes of CRBSI 6 , 7 , 8 . Conversely, a closed-type infusion device, which is easy to operate for the simultaneous administration of multiple drugs, is used broadly in clinical practice.…”

“…There are various reports about the requirement to disinfect the side tube of infusion device 9 , 10 , 11 ; however, there are still few reports on bacterial contamination in the closed-type infusion device, the requirement of flushing from the side tube after the administration of drugs, and the volume for flushing 12 . The most commonly reported dose of flush overseas was 5 mL 8 . On the other hand, in Japan, the dosage of flushes varies among medical institutions, and the Guidelines for Parenteral and Enteral Nutrition 1 do not provide any explanation or rationale for whether or not flushes should be performed in the line after lipid emulsion administration, which is an issue.…”

Brief Report on Double-Chamber Syringes Patents and Implications for Infusion Therapy Safety and Efficiency

“…However, the recommended steps for drug administration through a VAD are associated with longer preparation and administration times and the use of larger quantities of medical supplies such as syringes and needles. This may explain why VAD flushing is not always performed by healthcare professionals [15][16][17]. Likewise, the use of several syringes increases the number of catheter manipulations, which can enhance the possibility of catheter-related complications such as phlebitis, dislodgement, or accidental removal.…”