[sonia]

Hi Everyone,

I am in the healthcare industry and I am currently working on a project and trying to get a better understanding of IV therapies in the critical care setting, and needless to say my head is .
Can someone explain to me when do you (or MD) decides to use an IV push vs. a bag? Is it easier from a nurse's perspective in MICU/ SICU to use a push or a just hang a bag? Is hanging a bag more time consuming or more labor intensive than the push? Is a shorter time infusion better (2 min push vs 30 minute infusion? Help.
Thanks a lot.

Great website - the information I have gathered so far from you all has been very valuable.

[heartICU]

Well, in all honesty it depends on the medication and the patient situation. If your patient is coding, you don't have time to hang a bag of medication 30 minutes or however long it takes to infuse. But if it's a non-emergent situation, I prefer to hang my meds. I feel that is is safer for the patient. For example, if my order says reglan 10mg IV Q6h, I can push it slowly, but I prefer to just hang it in a 50cc bag of saline and run it over 15-30 minutes. My rationale is...if the patient has an adverse reaction to it, then you have more time to stop the infusion (and less med in infused) than if you push it. Some meds are meant to always be hung (i.e. potassium), some area meant to always be pushed (i.e. adenosine), and some can be pushed or hung depending on the situation (i.e. magnesium, vasopressin, epinephrine, calcium, etc). I will confess that when I am behind in my work and have a lot of IV meds to give, I will push the ones that are "safe" to be pushed...although when you look at the amount of time it takes to do a slow push vs. mix the med in a bag and hang it, they are probably about the same.

I guess to answer your question, some of it is judgement. It is probably easier to push meds, BUT...you have to be willing to deal with the consequences of a med infusing too fast. Sometimes those consequences are worth taking the extra time to hang the med.

[earle58]

it's usually a matter of how urgent the situation is, on whether it's infused or pushed.

[moonshadeau]

It also depends on the policy of the institution and what equipment you have at hand. My old job we NEVER administered Magnesium without a 50-100cc bag. In my new setting, there is a pump that will infuse a syringe at a given rate. Different practices in different institutions.

[oicu8bacilli]

As mentioned above, it really depends on what and why you are giving it. Nurses are the experts at administration rates and routes. Docs are great at determining what drug to use. If you push Pepcid you could kill your pt, if you hang a bag to give adenosine you are defeating the reason for giving it. You have just entered the world of “nursing judgment”; not a happy place to visit if you don’t understand the process and the why’s and why nots. Short answer: it all depends.

[AmiK25]

Ok, I have to ask...how can pushing Pepcid kill your patient? I know that rapid administration can cause hypotension and that arrhythmias are a possible side effect of h2 blockers but I have never seen either occur and I have pushed a lot of pepcid!

[oicu8bacilli]

Originally Posted by AmiK25

Ok, I have to ask...how can pushing Pepcid kill your patient? I know that rapid administration can cause hypotension and that arrhythmias are a possible side effect of h2 blockers but I have never seen either occur and I have pushed a lot of pepcid!

Maybe I should clarify between terms I use as “push” and “direct IV injection” – aka – “slow push”. Terms I keep in my head and derived from books. Direct IV, slow, means 2-3-5 mins to me; whatever the books say. Push, to me anyway, means squirt as fast as the catheter will allow. Sorry to confuse, then again people get the term parenteral confused with IV. It’s easy to see how that happens.

[jwBSN]

Originally Posted by sonia

Hi Everyone,

I am in the healthcare industry and I am currently working on a project and trying to get a better understanding of IV therapies in the critical care setting, and needless to say my head is .
Can someone explain to me when do you (or MD) decides to use an IV push vs. a bag? Is it easier from a nurse's perspective in MICU/ SICU to use a push or a just hang a bag? Is hanging a bag more time consuming or more labor intensive than the push? Is a shorter time infusion better (2 min push vs 30 minute infusion? Help.
Thanks a lot.

Great website - the information I have gathered so far from you all has been very valuable.

bottom line..... folllow the policies and procedures in your particluar facility to cover yourself...