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.
Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit or here for detailed instructions.
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
- 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