Thank you for the opportunity to respond to the letter from our peers in South Africa outlining objections to the National Infusion and Vascular Access Society (NIVAS) flushing guidance, which was published last year.
It should be noted that the flushing guidance sets out four options for actions to take after an intravenous (IV) infusion has finished. The arguments raised relate to option one only. The document sets out very clear guidance on how to flush IV giving sets and administer the remaining fluid/drug. What the guidance does not do is mandate that all IV infusions must have their giving sets flushed. This was a deliberate action by the board so that hospital trusts could make a decision locally about what practice they need to adopt on an individual basis.
I appreciate that not everyone agrees with the position NIVAS took with this issue, but we considered that it was pragmatic until we could review more evidence. Our focus was to give IV teams in the UK enough information so that they could make a decision as to what their collective practice should be. The flushing of IV giving sets has not been routinely undertaken in general IV therapy for over 20 years in the UK (outside of oncology or paediatrics). Mandating that every IV giving set should be flushed represents a big change in practice.
The next version of the flushing guidelines is due to be produced by the end of this month (January) and will pass through the Medusa board for review before publication (Medusa is a web-based resource set up by the Injectable Medicines Guide Multidisciplinary Advisory Group that provides an Injectable Medicines Guide.
The general consensus from NIVAS members and the NIVAS board, including some of our pharmacy members, is that option one, which is to continue to discard the giving set without flushing, will be removed and we will recommend that every effort is made to flush the IV giving set as set out in the other three options. There is more evidence available now to support this practice and NIVAS will be working with our industry partners to help find practical solutions to assist with this practice.
I thank our peers in South Africa for taking the time to write to the BJN and hope this response clarifies NIVAS's position.
The NIVAS Board, https://nivas.org.uk