The importance of flushing injection ports

Abstract

In 2014 and 2017, NHS Improvement released patient safety alerts about the dangers of residual anaesthetic drugs in cannulae and intravenous (i.v.) lines seriously harming patients when subsequent fluids or drugs are administered [1,2]. The 2017 action plan specified that 'all cannulae have been identified and either removed or adequately flushed' [2]. No description of how this flushing should be done was included and many anaesthetists believe that an i.v. infusion running through a cannula will achieve this aim.We were concerned that, although a running infusion will clear an i.v. line and cannula lumen, it may have no effect on residual anaesthetic drugs retained in the injection port of a cannula or a three-way tap. In order to assess this possibility, we tested two makes of cannula (Venflon TM Pro Safety (BD, Oxford, UK) 14G and Vasofix â Safety (B-Braun Melsungen AG, Melsungen, Germany, 16G) and a threeway tap (BD Connecta, BD, Oxford, UK).The cannula was connected to a 500-ml bag of saline via an i.v. line, this was used to flush the cannula and then the flow gate on the line was closed. One millilitre of methylene blue was then injected into the injection port of the cannula.The flow gate was then opened to flush the line and cannula until it ran clear, the flow gate was then closed. Five millilitres of saline was then injected into the injection port of the cannula. On doing this, evidence of dye contamination was clearly observed on a white swab placed at the cannula tip ( Fig. 1). Similar results were observed when the procedure was repeated using a different manufacturer's cannula and a three-way tap (Fig. 2).This demonstration shows that a running i.v. infusion line does not adequately remove residual contamination from cannulae or three-way taps. It is therefore essential that anaesthetists flush all injection ports before discharging patients from their care.

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

“…Also, in this study, some of the nurses (between 7.7% to 14%) reported the use of a running continuous infusion to perform flushing, which is not aligned with the good practices for the flushing procedure [ 18 , 19 , 25 , 26 , 27 ]. In fact, there is evidence that this practice does not remove the content of catheter lumen adequately [ 30 ], if the infusion is not saline or has associated medications [ 13 ]. Also, glucose infusions usually used in running continuous infusions contribute to the build-up of glucose deposits, which also increases the risk for complications [ 13 ].…”

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

“…Several of the included patents identified current challenges in infusion therapy as a significant reason for their development, such as the deliver a 0.9% sodium chloride flush after drug administration to assist pharmacodynamics [26], to ensure that the full dosage been correctly and timely administrated [27][28][29][30]. In fact, the main purpose of VAD flushing involves not only the maintenance of the PIVC patency, reducing build-up of blood or other products on the device's internal surface, and preventing the mixing of incompatible drugs [45][46][47][48][49], but also ensures that the prescribed amount of drug will be entirely administered [10,50]. Even in the DCS patents that did not specify that one of the chambers was intended for the flush solution, their background sections emphasize the need to flush the vascular access with 0.9% sodium chloride or another physiologically compatible flushing solution [31,35,38].…”

“…Likewise, after drug administration, a small amount of medication remains in both the tip of the syringe and in the VAD's lumen. The recurrence of this can pose several challenges to care efficiency and safety, given that the prescribed amount of medicine will not be entirely administered and can result in the mixing of incompatible drugs if sequential drug administration is performed [8][9][10][11].…”

The importance of flushing injection ports

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In 2014 and 2017, NHS Improvement released patient safety alerts about the dangers of residual anaesthetic drugs in cannulae and intravenous (i.v.) lines seriously harming patients when subsequent fluids or drugs are administered [1,2]. The 2017 action plan specified that 'all cannulae have been identified and either removed or adequately flushed' [2].

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“…lines seriously harming patients when subsequent fluids or drugs are administered [1,2]. The 2017 action plan specified that 'all cannulae have been identified and either removed or adequately flushed' [2]. No description of how this flushing should be done was included and many anaesthetists believe that an i.v.…”