[jamst149]

I'm a new nurse in the CT-ICU and have a lot to learn. I have a question regarding pushing dangerous drugs that generally require a slow push i.e. dilaudid, morphine, ativan.

It seems to be a common practice that nurses will often push these drugs into the most distant y site connector and let the pump slow do its work to push the drug to the pt. Being someone who always wants to know how/why here's my question. Say I am pushing 5mg of morphine into the previously mentioned distant y site connector where the maintence infusion is running at 75cc/hr. Is there a way I can calculate how the pt will actually recieve the medication? I guess I am trying to see if there is a way to determine mathematically how long of a time period the drug is taking to get into the pt. I am trying to ensure that I am giving these drugs safely.

[Angie O'Plasty, RN]

The best way to make sure that the patient is getting the drugs uniformly is to dilute and push from the closest port. I personally don't like to let the med float in with the IV fluids, I don't think that's all that safe - or guaranteed.

You might check with your Pharmacy on that question, though. They often know the answers to things like that and are a great resource.

[PICC ACE]

When you are pushing a med in a running line,the rate doesn't matter. Whether the rate is 500 or 5 ml/hr,you deliver the dose over,say,5 minutes. The concentration actually entering the patient is different,but 5 minutes is still 5 minutes.
Best practice is to use the injection site closest to the patient and there are a reasons for this. Imagine that you have are giving a med through a higher port and the patient picks that very moment to code or have an anaphylactic reaction to what you are giving. You now have an entire IV set full of something your patient doesn't need or is reacting to. Do you want to waste time disconnecting from the patient,aspirating from the IV device,taking the tubing out of the pump,flushing the line,reconnecting and THEN think about rescuing the patient? Probably not. Another example--let's say you hung a piggyback of Cipro 15 minutes ago and now you need to give your patient some sort of prn. Since Cipro should be considered incompatible with everything and you have an IV set full of Cipro,the only way to give your prn is to stop the infusion,flush the set from the closest port and then give the med. No practical way to do this if you use the higher ports.
Good luck to you.

[Zookeeper3]

My practice is that with these lines, one has a stopcock at the hub. Usually the NS line where antibiotics go is hooked up to run straight into the line and the "open" port faces out. When I want to push, say morphine, I pause that line- (put a 10cc syringe NS if there are additives to the fluid) to the available stopcock port, turn the stopcock closed to the fluid and flush or inject the med, then I flush with 10cc NS-turn the stopcock back to open the fluid line and restart the infusing fluids.

For some reason my stopcock irritates some and others have begun using it for our frequent IVP meds. It's closest to the line, you control the drug entering by flushing slow as you deem safe and compatability issues are eliminated. Plus you're not disconnecting lines which increases contamination/infection risks.

Great question!

[9309]

However you do it, you should know what the volume of the line is.

I have seen some practices that demonstrate that the nurse has nor taken this into account. For example:

The closest port to the patient may have a 1 cc volume. Very slow push of 1 cc of medication, followed by a much faster flush. The nurse believes he/she has delivered the med to the patient slowly. What they have done is delivered the med slowly to the iv tubing, and quickly to the pt.

Another example would be using a high port on a slow running iv, and having no idea when it is actually making it to the pt. Lets take an iv of ns running at 60 ml/hr. (an unusual rate, but good for this example) Getting 60 ml an hout, would be 1 cc a minute. If my distal port is 10 ml away from my pt, it will take 10 minutes to get there. As far as being well diluted using this method, I am skeptical. I think that for the most part, it probably travels as a bolus, with some dilution happening.

In the right situations, I will use a maintenence fluid line for meds, but it is a conscious decision taking into account the above factors.

9309

[cardiacRN2006]

Originally Posted by PICC ACE

When you are pushing a med in a running line,the rate doesn't matter. Whether the rate is 500 or 5 ml/hr,you deliver the dose over,say,5 minutes. The concentration actually entering the patient is different,but 5 minutes is still 5 minutes. .

I think what the OP is saying is that people aren't actually giving it over 5 mins. What they do is pick the furtherst port, injecting it all in at once, and letting the MIV push it in over whatever rate that it's running at.

Not best practice at all, but I see lots of people do it.