Real World vs. Nursing School: Surprising Revelations of Everyday Practices

In nursing, we’re taught certain conventions in school. But what happens when those practices don’t match up with real-life situations? Join me as we delve into the controversial topics of administering medication one-by-one through feeding tubes, the presence of air bubbles in IV lines, and the appropriate size of IV catheters for blood transfusions. Get ready for a shocking revelations that might just leave you questioning what you thought you knew about nursing. 

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Medication Administration via Feeding Tube

Nursing school convention: Give one med at a time with water flush between each med

Real-world nursing practice: Meds typically crushed together into one slurry/solution, done for efficiency given time constraints

Q: What is the best practice for administering multiple medications through a feeding tube?

A: Nursing school convention is safest practice

  • Crushing meds together inside the confines of a mortar increases interactions between meds and alters molecular structure and formulation
  • Meds can compete for absorption sites when given together. Separate administration allows better absorption

Air Bubbles in IV Lines

  • Nursing School Convention: Remove all air bubbles from IV lines
  • Real-world nursing practice: Small bubbles considered harmless

Q: Are small air bubbles in IV lines safe?

A: Nursing school convention is safest practice. Remove bubbles when possible.

  • Air bubbles behave differently than blood, clump together and can obstruct blood flow and prevent oxygen delivery
  • Small bubbles can lodge in pulmonary arterioles
  • Large bubbles can obstruct right ventricle output
  • Bubbles can pass through PFO/ASD to left heart which put the patient at risk of a CVA or MI

IV Cather Size for Blood Transfusions

  • Nursing School Convention: Must use a minimum 20g IV catheter
  • Real-world nursing: Elderly/frail patients may only tolerate smaller gauge

Q: Are 22g IV catheters compatible with blood transfusions?

A: A 22g is adequate for a stable patient

Image from the International Emergency Medicine Education Project
  • Minimum catheter size depends on rate needed
    • 18g: 5.5 L/hr
    • 20g: 3.6 L/hr
    • 22g: 2.2 L/hr
  • RBCs much smaller than 22g diameter