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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer a prescribed intravenous (IV) push medication through a client's non-valved central venous catheter (CVC). Arrange the following steps in the correct order of execution. All steps must be used.

  1. 1Scrub the needleless connector with an antimicrobial swab and allow it to dry completely.
  2. 2Attach a syringe of normal saline, aspirate for blood return, and flush the catheter.
  3. 3Administer the prescribed intravenous medication over the recommended duration.
  4. 4Flush the catheter with normal saline using a push-pause technique.
  5. 5Instill the prescribed heparin flush solution into the catheter lumen.

Answer

The correct sequence for administering an IV push medication through a non-valved central venous catheter is: Scrub the connector, aspirate and flush with normal saline, administer the medication, flush with normal saline again using a push-pause technique, and finally instill the heparin flush.
The SASH sequence (Saline, Administer, Saline, Heparin) is the standard evidence-based practice for administering medications through a non-valved central venous catheter. Asepsis must be established first by scrubbing the hub. An initial saline flush with aspiration confirms placement. After medication administration, a second saline flush clears the drug. Finally, a heparin flush maintains patency.

Step-by-Step Solution

1
Scrub the needleless connector with an antimicrobial swab and allow it to dry completely.
The entry port is disinfected.
Prevents the introduction of microorganisms into the bloodstream, minimizing the risk of central line-associated bloodstream infections (CLABSI).
2
Attach a syringe of normal saline, aspirate for blood return, and flush the catheter.
Placement and patency are verified.
Aspiration ensures the catheter tip is appropriately situated in the vascular space, while the initial flush ensures there is no resistance or occlusion.
3
Administer the prescribed intravenous medication over the recommended duration.
The medication is delivered safely.
Administering at the correct rate prevents adverse reactions and toxicity.
4
Flush the catheter with normal saline using a push-pause technique.
The medication is cleared from the line.
Ensures the entire dose reaches the vascular system and clears the line to prevent incompatibility with subsequent infusions. The push-pause method creates turbulence to clean the catheter walls.
5
Instill the prescribed heparin flush solution into the catheter lumen.
The catheter is locked with heparin.
Maintains catheter patency in non-valved central lines by preventing blood coagulation inside the lumen between uses.

Key Concept

The SASH (Saline, Administer, Saline, Heparin) method ensures safe medication administration and maintains patency in non-valved central venous catheters.
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Topics

Pharmacological and Parenteral Therapies

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