Administration of Medication or Flush Through Central Venous Line

<< CARDIOVASCULAR

  • *This procedure is typically performed by a Registered Nurse
    • The use of this procedure guideline assumes that the registered nurse has the nursing education and skills to perform this task. This procedure guideline does not replace nursing clinical judgment.  The registered nurse should contact the student’s health care team for guidance on how to perform this procedure.
  • Determine the need for assistance of another person to hold or comfort the student while performing the procedure to ensure that sterile technique is used
  • A single use syringe should never be used more than once (even on the same lumen)

Considerations:

  • This is a complex procedure that requires the registered nurse to have the necessary education, training and experience to perform this procedure.
  • This procedure requires additional resources including a second person to assist with the procedure, 30 minutes of uninterrupted time, and the ability to perform this procedure using Aseptic non touch technique (ANTT®).  
  • If the registered nurse does not have the capability to perform this procedure, then the registered nurse should discuss with the student’s parents/guardians and health care provider to arrange a different plan. 
  • Be sure to take steps to ensure student’s privacy when performing procedure. 
  • Determine the need for assistance of another person to hold or comfort the student while performing the procedure to ensure that Aseptic non touch technique (ANTT®) is used. 
  • A single use syringe should never be used more than once (even on the same lumen).  
  • A 10 ml syringe filled with normal saline should not be divided into several doses and used for multiple lumens.  
  • Student should have an emergency kit readily available at all times (including field trips). 
  • Use single-dose vials or prefilled, labeled syringes for all vascular access device flushing and locking.
  • During the initial flush, slowly aspirate the vascular access device for free-flowing blood return that is the color and consistency of whole blood, an important component of assessing catheter function prior to administration of medications and solutions. 
  • Do not forcibly flush any vascular access device with any syringe size. If resistance is met and/or no blood return noted, take further steps (e.g., checking for closed clamps or kinked sets, removing dressing) to locate an external cause of the obstruction. 
  • Be sure to determine what type of needleless connector set the student uses and follow the appropriate clamping sequence to reduce blood reflux based on type of needleless connector used:  
  • Negative displacement – flush, clamp, disconnect  
  • Positive displacement – flush, disconnect, clamp  
  • Neutral and antireflux – no specific sequence required 
  • NOTE: The procedure below outlines the steps for a negative displacement central line, you will need to edit the procedure for positive or neutral displacement central lines.  

Supplies:

  • Student’s Individualized Health Care Plan (IHCP) and health care provider’s order
  • Parent/Guardian authorization form
  • Gloves
  • 70% isopropyl alcohol pads or other antimicrobial swab as directed by student’s health care provider’s orders
  • 10 ml syringes filled with normal saline
  • Heparin flush, if ordered
  • Spare chlorhexidine dressing kit
  • Chlorhexidine catheter dressing kit:
    • Sterile gloves 
    • Mask 
    • No sting barrier 
    • 2% chlorhexidine gluconate in 70% isopropyl alcohol, Povidone iodine swab sticks, or student specific cleaning supplies 
    • Alcohol wipes 
    • Sterile gauze 
    • Transparent occlusive dressing  
    • Adhesive tape 
    • Hand sanitizer 
    • Adhesive remover 
    • Biopatch 
    • Extra clamp 
  • Emergency Kit:
    • Chlorhexidine kit
    • Catheter cap
    • Stat lock
    • Clean gloves
    • Flushing supplies:
      • Alcohol wipes
      • 10 ml syringes
      • Heparin flush

Procedure:

Flushing CVL ProcedureDownload Procedure
Flushing CVL Skill CompetencyDownload Skill Competency
  1. Review healthcare provider’s order
  2. Ensure proper documentation of parent/guardian authorization to administer medication
  3. Clean your workstation with soap and water or disinfectant wipe
  4. Gather supplies and place on clean surface
  5. Check for the Six Rights
    1. The right student
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
  6. Ensure that the medication has not expired
    • If medication is expired do not administer it, contact parent/guardian and health care provider
  7. Review the student’s allergy status
  8. Explain the procedure to the student at their level of understanding
  9. Position student
  10. Wash hands
  11. Put on gloves
  12. Place clean drape on workstation
  13. On clean workstation place two saline syringes, medication syringe, and heparin syringe along with four 70% isopropyl alcohol pads or other antimicrobial swab as directed by student’s health care provider’s order
  14. Prepare the saline and heparin syringes for administration
    • Remove the cap from the saline syringe being careful to not touch the inside of the cap or the tip of the syringe
    • Lay the cap down on your clean workstation with the inside of the cap facing up
    • Remove air from syringe by pulling back on plunger, then pushing forward until all air is removed
      • Tap the syringe to move air bubbles, if needed
    • Pick up the cap, being careful not to touch the inside of the cap or the tip of the syringe and replace the cap on the tip of the syringe
  15. Repeat step 14 for the other saline syringe and the heparin syringe
  16. Inspect the medication syringe for leaks, cracks, particulate matter, and clarity of medication
    • Medication syringe should not need to have air removed if prepared by a pharmacy
    • If air bubbles are present, gently tap syringe and dispel air bubbles
  17. Assist student in removing clothing to uncover the dressing
  18. Examine tubing and cap to ensure that all components of the system are compatible and secured, to minimize leaks and breaks in the system
  19. Scrub the access cap for a time of no less than 15 seconds, using 70% isopropyl alcohol (or cleaning agent as prescribed) and vigorous scrubbing
    • Allow access cap to air dry for at least 15 seconds, do not blow or fan
  20. Hold on to the needleless syringe connector and attach the prefilled 10ml normal saline syringe into the center of the cap while maintaining the sterility of the syringe tip
    • A smaller syringe may push too much pressure into the catheter and cause it to burst
  21. Unclamp the line
  22.  Slowly inject normal saline into vascular access device, noting any resistance or sluggishness of flow, and slowly aspirate until brisk blood return is obtained
    • Inability to flush or absence of blood return from a central vascular access device requires further investigation about the causes, see below for Problems Flushing the Line
    • Push the normal saline into the catheter using the push-pause method (10 short boluses of 1 ml interrupted by brief pauses)
  23. Clamp the line
  24. Hold on to the needleless syringe connector and disconnect the syringe from injection port after flushing
  25. If medication is to be administered, review the six rights of medication administration again to ensure that it is for:
    • The right child
    • The right medication
    • The right dose
    • Being given at the right time
    • Being given by the right route
    • Being given for the right reason
  26.  Scrub the access cap for a time of no less than 15 seconds (or the amount of time indicated on student’s Individualized Healthcare Plan (IHP), using 70% isopropyl alcohol (or cleaning agent as prescribed) and vigorous scrubbing
    • Allow access cap to air dry for at least 15 seconds, do not blow or fan
  27. Hold on to the needleless syringe connector and attach the medication syringe
  28. Unclamp the line
  29. Slowly push the medication from the syringe per health care provider’s orders or over the recommended amount of time per drug manufacturer  
  30. Clamp line
  31. Hold on to the needleless syringe connector and remove medication syringe
  32.  Scrub the access cap for a time of no less than 15 seconds (or the amount of time indicated on student’s Individualized Healthcare Plan (IHP), using 70% isopropyl alcohol (or cleaning agent as prescribed) and vigorous scrubbing
    • Allow access cap to air dry for at least 15 seconds, do not blow or fan
  33. Hold on to the needleless syringe connector and attach the prefilled 10ml normal saline syringe
  34. Unclamp the line
  35. Flush with 10ml normal saline using the push-pause method
    • Inject the normal saline flush at the same rate as the medication administration rate to ensure that the entire dose has reached the bloodstream
  36. Clamp line
  37. Hold on to the needleless syringe connector and disconnect the syringe after flushing
  38. Scrub the access cap for a time of no less than 15 seconds (or the amount of time indicated on student’s Individualized Healthcare Plan (IHP), using 70% isopropyl alcohol (or cleaning agent as prescribed) and vigorous scrubbing
    • Allow access cap to air dry for at least 15 seconds, do not blow or fan
  39. Hold on to the needleless syringe connector and attach the prefilled Heparin syringe
  40. Unclamp the line
  41. Administer the Heparin flush to cap the lumen using the push-pull method
  42. Clamp the line
  43. Hold on to the needleless syringe connector and remove the syringe from injection port after flushing
  44. Discard used supplies in appropriate receptacles
  45. Remove gloves
  46. Wash hands
  47. Assist student in dressing
  48. Document assessment, intervention and outcome in student’s health care record
  49. Follow up with student’s parents/guardian and health care provider as needed

Problems Flushing the Line:

If there is trouble flushing the line (inability to flush or sluggish line), the following steps should be taken:

  1. Assess for possible causes of catheter occlusions
  2. Have the student change positions by lifting the arm on the side of the insertion site, turning from side to side, coughing, or other maneuvers to change body/catheter position
    • If still unable to flush after completing the above steps, remove the syringe and reclamp the line
    • Contact parents/guardians and healthcare provider

Emergency care:

If the catheter comes out:

  1. Wash hands
  2. Put on gloves
  3. Hold firm pressure over the site for at least 5 minutes
  4. Cover it with gauze and tape
  5. Call parents/guardian and student’s healthcare provider immediately

References:

Froedtert and The Medical College of Wisconsin. (2019). Home infusion IV administration using IV push (S-A-S-H method). Retrieved June 9, 2023, from https://www.froedtert.com/sites/default/files/upload/docs/patients-visitors/pharmacy/home-infusion/iv-push-administration-sash.pdf

Infusion Nurses Society, Inc. (2021). Aseptic non touch technique (ANTT®). In Policies and procedures for infusion therapy: Home infusion. (2nd Ed.). (pp. 42-44).

Infusion Nurses Society, Inc. (2021). Infusion medication and solution administration. In Policies and procedures for infusion therapy: Home infusion. (2nd Ed.). (pp.245-261).

Infusion Nurses Society, Inc. (2021). Maintaining vascular access device patency: Flushing and locking. In Policies and procedures for infusion therapy: Home infusion. (2nd Ed.). (pp.124-130).

Lynn, P. (2019). Changing the dressing and flushing central venous access device. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 355-357).

Nickel, B. (2021).Infusion therapy standards of practice 2021 – Mitigating central line complications. [Webinar]. BD. Retrieved June 9, 2023, from https://event.webcasts.com/starthere.jsp?ei=1476887&tp_key=575983a54f

Pediatric Home Services. (2015). Flush an IV catheter using the sash method. . Retrieved June 8, 2023, from https://www.pediatrichomeservice.com/tips-how-tos/flush-an-iv-catheter-using-the-sash-method/?play=1

Ullman, A.J. and Chopra, V. (2022, November 22). Routine care and maintenance of intravenous devices. In A. Cochran & I. Davidson (Eds.), UpToDate. Retrieved June 9, 2023, from https://www.uptodate.com/contents/routine-care-and-maintenance-of-intravenous-devices?search=central%20venous%20line%20care&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3631889060

Page last reviewed: January 31, 2025
Page last updated: January 31, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.