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
- 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