How to Teach Proper Saline Flush Technique (Push-Pause Method) in Simulation Labs

Properly teaching the saline flush technique in simulation labs focuses on replacing ineffective habits with the push-pause method, helping nursing students understand both the reasoning and correct execution behind safe IV catheter maintenance.

Key points:

• The importance of saline flushing in preventing blockages, infections, and medication buildup in IV catheters
• Why the continuous push method is ineffective and can leave residue inside the catheter
• How the push-pause method creates turbulent flow that better clears the catheter walls
• The core principle of injecting saline in short, forceful bursts rather than a steady stream
• Why explaining the “why” behind the technique improves student understanding and adoption
• The essential simulation lab setup, including syringes, IV catheters, and training manikins
• The value of live demonstrations to clearly show each step of the push-pause technique

Professional nurses must often administer a saline flush through an IV catheter. The purpose is to clean and clear out the IV catheter by forcing residual medication into the bloodstream. Not only does this help treat the patient, but it also prevents blockages, medication buildup, and reduces the risk of infections.

Nursing students must learn the proper saline flush technique to prepare themselves for the real-life task in a clinical environment. Unfortunately, too many beginner students fail to perform the saline flush technique properly. Many of them use the continuous push method to flush the catheter, but that technique is too insufficient and can lead to infections and blockages.

The Push-Pause Method

When nursing educators teach about the proper saline flush technique in their simulation labs, they are better off teaching the push-pause method to students. The push-pause saline flush technique does not flush with a steady stream of saline. Instead, the nurse injects the saline solution in short, fast, forceful bursts.

In other words, rather than applying steady pressure to the syringe, you would apply quick, repeated pressure where you would push and pause the syringe’s plunger over and over again. Each push will inject a small amount of saline fluid, usually around 1 to 2 mL per push. So, if you used a standard 10 mL syringe for the injections, you could push and pause around 5 to 10 times.

The pulsing action of the push-pause method produces a turbulent, erratic flow of the solution within the IV catheter. It is proven to be a more effective way to flush out the catheter to reduce the risk of blockage and infection. That is why every nursing educator should teach the push-pause method in their simulation laboratories.

How to Teach the Push-Pause Method Properly

A simulation lab is the perfect environment to teach the push-pause method to students. It will help your students break any current bad habits of flushing IV catheters, such as the habit of using the continuous flush method. You’ll want to prove the effectiveness of the push-pause method to your students, so they will understand that it is a better technique to use. 

Here are the general steps involved in teaching the push-pause saline flush method correctly in a simulation lab:

1) Explain Why the Push-Pause Method Works

Before students even begin experimenting with the push-pause method, they must understand why it works. But first, take some time to explain why the continuous push method does not work.

For instance, the continuous push method quickly pushes saline fluid to the center of the catheter. Once this happens, it causes the fluid near the sides of the catheter to move more slowly, leaving behind blood and medication residue. That is what causes blockages in the IV catheter.

The push-pause method puts the saline solution into a bursting and swirling motion, causing the saline fluid to brush up against the sides of the catheters. As a result, much of the residue is cleaned away to reduce the risk of blockage.

2) Set up the Simulation Lab

The next step is to set up the simulation lab with the proper medical equipment and accessories. These include:

• IV catheters

• Pre-filled saline syringes

• Simulated blood

• Manikins

• IV training arm

• Alcohol Swab

You don’t need too many supplies for the simulation lab. All your students really need is the syringe filled with the saline solution and a simulated patient to practice on, such as a manikin or IV training arm. The simulated blood is optional, but it can help add realism to the simulation.

3) Demonstrate the Push-Pause Method

Show your students how to do the push-pause method by demonstrating the technique yourself. Grab a pre-filled saline syringe and demonstrate on the manikin or IV training arm. Make sure you verbally explain to your students each step of the push-pause process as you’re performing it live for them.

These steps include:

1. Prepare the injection site with the alcohol swab

2. Prime the syringe by pulling the plunger down to break the seal

3. Gently push the plunger up to remove air bubbles without squirting the saline solution fluid

4. Stick the needle into the catheter tube. 

5. Apply a quick, forceful push to inject between 1 and 2 mL of the saline solution

6. Stop or “pause” after about half a second. 

7. Forcefully inject another 1 to 2 mL of the saline.

8. Stop after another half second.

9. Keep repeating this until you inject between 5 and 10 mL.

10. Leave about 0.5 to 1 mL of solution to prevent air from coming out into the catheter.

Your students should now have a good idea of how to perform the push-pause method themselves. 

4) Let Your Students Practice

Now comes the chance to let your students practice the push-pause method. It is better to let one student practice at a time while you and the rest of the class observe them. That will allow you to evaluate their performance and point out the right and wrong steps taken. 

Of course, make it clear to the students that it is okay to make mistakes during the simulation. The purpose is to learn and become better by allowing the entire class to learn from the mistakes. Continue to let each student practice the push-pause method until they can all perform it flawlessly. 

What to Evaluate

Here are some of the things to watch for when evaluating your students

• Did they swab the arm before administering the technique?

• Did they revert to the continuous push method at any point?

• Did they leave a little bit of saline solution in the syringe at the end to prevent pushing air?

• Did they push and pause at the appropriate intervals? 

Most students will learn the process through trial and error. Give them plenty of freedom to make mistakes without feeling like they will be punished for it. The more they practice, the better they will get at it. Please reaffirm that to them. 

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