The bolus or continuous infusion of saline prior to and after medication delivery is a critical requirement of safe IV practice. However, little evidence exists to guide practice, leading to substantial variation in practice and outcome in terms of catheter survival time. This presentation will review the latest published and recently collected unpublished evidence regarding how clinicians flush peripheral intravenous catheters (PIVCs). This evidence will help to improve our understanding of the importance of flushing for 1) the clearance of catheters of drug and thrombotic precipitate and 2) importantly discuss the impact of flushing on the vein, its physiology and risk of thrombosis and thrombophlebitis. This presentation will argue for a balance to be achieved between clearing the catheter without irritating the vein. Evidence-based guidance will be provided in terms of flushing frequency, volume, catheter size and the rate of flushing to complement existing INS Standard of Practice recommendations and identify areas of further study to further inform the guidelines.

Learning Objectives: At the conclusion of this session, participants will be able to: 

1. Discuss why flushing of IV catheters is required and how flushing can remove intracatheter precipitate. 
2. Describe the relationship between catheter size, flushing velocity, and shear stress.
3. Explain how forceful flushing might impact the catheter and the infused vein.
4. Identify the impact of adjusting saline flushing frequency, volume, and rate on PIVC failure and associated thrombosis.
5. Review individual flushing practice in light of the INS Standards of Practice and assess whether individual practice meets the recommendation.
6. Identify practical solutions that can be used to optimize flushing practice.

Contact Hours: 1
CRNI® RUs: 2