![]() ![]() This residual volume is likely to be more clinically significant for small infusions of ≤100ml and, in particular, 50ml bags (Harding et al, 2020). Once the bag is empty, the infusion set and tubing will still contain around 20-30ml of medicine, depending on the type/length of tube and administration method used (gravity or pump). Medicine is added to the bag or available as a ready-to-administer infusion, and the bag is connected to the vascular access device via an infusion set with a needle-free connector. It allows fast dilution into the bloodstream and reduces the risk of chemical phlebitis (inflammatory response). This method is used for medicines that need to be administered at a slower rate than via syringe injection (for example, certain antibiotics). ![]() Syringe infusion sets hold around 2ml of solution, depending on the type and length of the tube, and the set used. When using a syringe pump, an IV extension tube connects the patient’s venous access device to the syringe. Injecting directly into the peripheral venous access does not require an infusion set and the cannula should be flushed before and after administering the IV medicine, according to local policy. IV infusion sets administering large-volume medicine infusions (≥250ml) or hydration fluids do not need flushing as the proportion of medicine remaining in the set will be relatively small. There are several infusion methods and the potential impact of flushing/lack of flushing depends on the dead space of the infusion-giving set used and the volume of the infusion. Infusion sets can be used continuously for multiple fluid infusions such as sodium chloride 0.9%, following local policy. It is important to avoid reusing infusion-giving sets for different medicine solutions if the solutions are not compatible. The NIVAS updated guidance is summarised below. The guidance should be used in conjunction with local medicines policy and NICE guidance on IV fluid therapy for hospitalised adults (NICE, 2017). The NIVAS (2021) guidance gives practitioners and organisations an overview of residual medicine volumes in infusion sets, along with best-practice recommendations for flushing based on the available evidence and expert consensus. To help address the under-recognised problem of underdosing due to non-flushing, NIVAS has updated its guidance on line flushing to help healthcare organisations review their practice and procedures, and develop local policies to minimise the risks of underdosing. One problem is a lack of national guidance, standardisation or evidence to support flushing technique (NIVAS, 2021). The same study showed that antibiotics were commonly infused and up to 21% of each antibiotic dose was often discarded. Unless flushing is undertaken after infusion, residual drugs can occur in the ‘dead space’ in infusion sets, causing underdosing in small-volume infusions of 90% of gravity infusions and 61% of pump infusions in all areas except oncology, which was the only area where flushing was standard practice (Harding et al, 2020). As NICE (2017) states: “Although mismanagement of fluid therapy is rarely reported as being responsible for patient harm, it is likely that as many as one in five patients on IV fluids and electrolytes suffer complications or morbidity due to their inappropriate administration.” Hospitalised adults commonly need intravenous (IV) fluid therapy to prevent or correct problems with their fluid and/or electrolyte status, so assessing and managing patients’ fluid and electrolyte needs is fundamental to good patient care (National Institute for Health and Care Excellence, 2017). Practical guidelines on fluid therapy pdf pdf#
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