A Step by Step Guide to the SASH Method

Before you start the SASH method, your first step should always be cleaning the surface and supplies that you will be using, washing your hands, and wearing a mask.

Start by cleaning the surface with a surface disinfectant and cleaning your supplies with an alcohol prep pad for at least 30 seconds, or a good rule of thumb my home care nurse taught me is ‘how long it takes you to sing happy birthday twice’. By cleaning the surface and supplies, you are removing any germs and bacteria that could lead to infection or your PICC, Port, Midline or peripheral IV. This step is important because the vascular access device line has direct access to the bloodstream and can cause infections if it is not taken care of properly.

Check-in with your clinician or infusion nurse to see how often you should follow the SASH method according to how often you need to clean your line and administer medicine. Once you have cleaned the items you will be using, it is also key before you begin the SASH method. 

Step One: Saline Flush

  After you have cleaned the surface, the supplies, and your hands, and have masked up, you are all set to begin the first step of the SASH method. The “S” in SASH stands for saline flush, the first step of the flush process. You will begin the saline flush by prepping your normal saline flush syringe . The best way to do this is by wiping the part of the syringe that will connect to the line with an alcohol prep pad for at least 30 seconds. A good rule of thumb is to wipe the needless connector with the alcohol pad for fifteen seconds and allow it 15 seconds to dry afterward. After cleaning the needless connector, you can attach the saline syringe to your line and unclamp it to flush the line with the saline solution in the syringe. While each saline syringe is typically filled with 10 mL of fluid, some patients do not need the full dose, so it is important to check in with your clinician. In the last piece of this step, you will reclamp the syringe. This step is important to ensure that the line is clear of any bacteria and residue before you let any medication through the line to get to the bloodstream.

Step 2: Administer Medication

The “A” in the SASH acronym stands for administer medication. Similar to the first stage of the SASH Method, this stage starts with cleaning a needleless connector, but this time you will be cleaning the extension tube filled with medicine instead of the normal saline flush syringe. Just like when you clear the lines with a saline flush, you will attach the tubing of the medication and unclamp it to release the medicine. It is important to note the flow rate your clinician has recommended for the infusion rate. Once the entire extension tube has been released into the line, you can reclamp the syringe, removing it from the vascular access line.

Step Three: Saline Flush

The second “S” in the SASH acronym stands for the same thing as the first, saline flush. While these two steps are similar, they are not exactly the same, so be sure to pay attention to the key differences here that are important to take care of your vascular access line correctly. Following a flush of medication, it is always a good idea to cleanse the area and wash your hands again. Next, you will clean the needleless connectors on both the lines and the saline syringe. Once both connectors have been cleaned, you can attach the saline syringe. From here, follow the typical steps of unclamping the syringe to flush the lines with saline, reclamping when you have finished the right dose, and lastly disconnecting the syringe. It is important to do a saline flush after any medication has gone through the lines to be sure that future medications do not mix with any residue that could be left over from a previous medication.

Step Four: Heparin Flush

The last letter in the SASH acronym stands for Heparin. Just like the last three stages, you will begin here by cleaning the needleless connector. Next, you will attach the heparin syringe, unclamp to flush the lines with the heparin, and reclamp when you are done. Similar to the saline flush, not all patients will need a full syringe of heparin, so your clinician will give you instructions on the dosing that best fits your needs. The only difference in this step is that you will end the process by cleaning the needleless connector on the line and connecting the disinfectant cap. At this point, you have finished the SASH method. 

In conclusion, using the SASH Method is a good way to keep IV line patients safe by preventing complications . This method walks you through which order to flush your lines and makes sure that the correct cleaning measures are used along the way. For your next flush, use the SASH method as a guideline to successfully take care of your line!