[maygrad07]

this is a simple question but has seemed to complicate my mind.
how do you give an IV pain med/nausea med when there is fluids running.
many nurses on my floor do different ways. lets say the fluids are running 100/hr. do you pause them, flush a 10cc NS, give the pain IVmed, flush again and restart
or do you give it slowly into the port of the IV while the fluids are running?
lets say its not compatible with the piggy back thats running, how do you give it then?
and when you dilute meds, and then how do you give that IV med while a fluid is running? ahhh please someone help, i am so confused!!!

[SusanNC]

Hi May,

If they have NS running, we just put the pain med in the most proximal port. What most people do if they have something else running - they'll crimp the tubing closest to the port, flush, put the pain med in the port, flush - uncrimp and let the fluids resume running. Re: drips, they usually have separate lines (not to be mixed with anything). If you're unsure about any IV meds, always check your drug book and hospital protocal - better safe than sorry. Just a handy tip - in the back of most IV fluid books, there's a table with all standard IV fluids (NS, D5, LR, etc.) - along with a list of IV antibiotics - showing what's compatible w/what (so you can piggyback them). Hope this helps...

[Daytonite]

Your facility should have a nursing policy on this. You should try to find it. There should also be a guideline somewhere (perhaps the pharmacy has one) on how fast any IV medication can be pushed into a vein. Or, you should refer to a nursing drug reference. No drug should just be bolused into any patient without checking this information first due to the side effects the patient could experience. If they don't here is one from another facility that you can refer to:

• http://www.musc.edu/pharmacyservices/PnP/f23.pdf

Any IV push medication is administered by the SAS method. SAS is an acronym for Saline-Administer medication-Saline. You stop the IV infusion, pinch off the tubing above the port you are injecting the medication into, flush with 1 to 3 cc's of saline, administer the direct IV push of medication at the safe rate of injection, then follow that with another flush of 1 to 3 cc's of saline and restart the IV infusion. In this way you are sandwiching the IV medication in between saline which separates it from the main IV fluid that is already in the IV line so no intermixing can occur. This avoids the potential problem of incompatibilities of the various solutions. Saline is compatible with everything.

[deeDawntee]

You've already gotten some good advice.
A couple of things, if there is an IV fluid running, we don't dilute the IV pushes because it dilutes while you are pushing it in. Personally, I never "slam" in an IV push drug no matter what the rate of the IV fluid (unless its Adenosine, of course, and that is how that med is given--stops the heart for a few seconds, pretty freaky, let me tell you!). If I am pushing into IV fluid, I will push a little and wait, push and wait etc, so that I know it is being diluted.

Often we will have a port with NS running at TKO just for IV push meds and we label this with tape right at the port. This is a very important safety measure in the ICU, so in a code situation, emergent meds can be given quickly without trying to figure out which line is which. This is done at the nurse's discretion.

It is a must to check your compatibilities, we have a computer program called Micromedex that is really nice and we can print out a sheet and leave for the next nurses, so we all know at a glance what is compatible with what. It is also a great idea to report to the next nurse if you do find something that is incompatible.

You are asking some great questions! keep up the good work!