IVP into Primary IV Tubing?

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    I was in the ICU for clinical giving IV morphine through a PICC line pushing it slowly over the designated time. The ICU nurse who I have a lot a respect for laughed and said he usually puts morphine in the IV line and let it run it because you won't have time to slowly push and flush IV meds in the ICU. There was NS running at 100ml/hour. Patient BP was in the low 100s with hx of colitis, ruptured bowel, peritonitis and sepsis on no pressors and had VAP.

    Another nurse also did this. In addition she ran an abx with Diprivan through the same line because they were compatible and had only one port flushing on the PICC?

    What am I suppose to think about this? In nursing school this is a big no no but working in an ED I know school and real life are different. Thanks:uhoh21:
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  3. 10 Comments so far...

  4. 0
    Depends a bit on the medication given. But I don't add any medications to my vasopressors/inotropes or sedation that doesn't run for 24 hours. You are inadvertently giving a bolus of Diprivan if you are running an antibiotic on the same line for less then 24 hours and it leads to fluctuations in your sedation level whenever you start or stop an infusion over the same line.

    As for pushing meds it all depends again. When something needs to be given slow I either dilute it to 20 cc and give it via a syringe pump in e.g. 15 minutes. Or when it is a small volume (say morphine) I either bolus it rapidly (e.g. post CABG etc. that can handle it and have need for quick pain relief) or inject it in the proximal port of the CVP-line and have the flush from the CVP push it in over the next hour or so (as it is only 3 ml/h).

    So for my CABG patient a much used regimen in our center is 5 mg Morphine SC and 2 - 4 mg morphine IV and then leave 2 more mg Morphine in the CVP lumen of the Swan to be pushed in slower. Naturally these amounts are based on an obese man that is otherwise fit but feels he is more sick than all the other CABG patients because well: he is a man so it automatically hurts more.

    For my frail old lady that they went to collect in her house because she fell and broke her hip and is now in our ICU because only one in 10 heartbeats is considered a normal heart beat. Well she tends to get a morphine drip with or without PCA or we give the morphine in the CVP-line and have it pushed in over a longer time.
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    If you've got two open ports on your main line, then split the morphine between the two. You don't have to stand there forever slowly pushing it and it still won't hit the patient like a ton of bricks.
  6. 0
    If it's IVP I give it just that way: push it. Don't let the IVF or whatever push it in. And as long as 2 meds are compatible, they can be run together.
  7. 1
    Officially there is not enough turbulence at the y-ports of IV tubing to adequately flush meds into the patient without leaving residual behind.
    So if you are connecting IVP meds into the y-port of IV tubing you should be flushing. It is lazy and unsafe not to do so.

    Ask your manager if they think it is okay to push a med into the IV tubing and let the basal IV fluid 'push' the med into the patient. See what they say!
    sapphire18 likes this.
  8. 0
    I dont see a problem. If it can mix...its good
  9. 0
    I always flush after giving an IVP med.
  10. 0
    4:12 am by 8mpg i dont see a problem. if it can mix...its good

    you don't see a problem with residual medication sitting at the y-site injection port and not flushing?

    medication 'a' is dripping into the patient and you ivp medication 'b' at the y-site without flushing because you think "well 'a' and 'b' are compatible, what does it matter derp".
    later medication 'a' is still infusing. you ivp medication 'c' into the y-site without flushing thinking "derp well 'a' and 'c' are compatible so why do i need to flush".

    the problem is that 'b' and 'c' and 'x' are potentially incompatible with one another, irregardless of their compatibility with 'a'.
  11. 0
    As long as its compatible, just push it with a flush behind. I have NEVER seen anyone push drugs in the ICU over the "specified" amount of time. For example: Protonix says give over 10 minutes.... seriously? Is there anyone who can honestly say they do that? If so, you need a gold star.

    Dont get me wrong, I'm not saying I 'superflush' 5 mg lopressor or dig or that kind of stuff, but over 10 minutes? C'mon....
  12. 0
    We always hang protonix.


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