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Tam Metin
Complete intravenous (IV) drug administration to a pediatric patient is an important nursing intervention. Verification of the amount of flush solution that is necessary to deliver > 95% of an IV medication to the patient was the goal of a laboratory demonstration and a clinical study. In the laboratory, it was determined that three times the volume of the dead space of the IV tubing was the required volume needed to flush dye from IV administration sets. This principle was then applied to pediatric patients receiving tobramycin medication therapy. Nurses administered tobramycin through 27 IV solusets of patients using three measured volumes of IV flush solution. Samples were collected from the IV tubing and analyzed to measure the concentration of tobramycin in the tubing. All three resulted in administration of > 95% of the medication. A nursing procedure was written to standardize the administration of IV medications to pediatric patients using two times the volume of the dead space of the IV tubing as the flush volume.
The practice of determining the amount of flush needed for the delivery of intravenous (IV) medications via a soluset has relied heavily upon tradition rather than evidence-based practice. Administering IV medications to pediatric patients usually requires the use of a soluset and IV tubing to decrease the risk of fluid overload. A nurse injects the medication into a soluset, runs it through the tubing in a timed way until the soluset is empty, and then adds a flush solution to the soluset to accommodate for the dead space of the IV tubing and complete the delivery of the medication to the patient. Intraluminal tubing diameter and tubing length determine the dead space of the IV tubing.
Standard practice at The Children's Hospital of Philadelphia (CHOP) was to dilute the medication in the soluset with a volume of 15 to 20 mL and then flush with the same volume. As pump manufacturers changed and, therefore, pump tubing, nurses continued to use these same volumes for flushing. Nurses also used similar volumes for the gravity soluset. If extension tubing was added to the soluset, nursing staff still infused the 15-20 mL of flush. With this practice, some of the diluted medication may be delivered to the child, but some...