How fast to push IV meds

  1. Hi,

    I'm wondering if anyone has some general guidelines for pushing IV meds. I have asked around on my unit and I am getting some pretty vague answers. I realize that times may differ for different meds but does anyone have some rules of thumb they use? Some meds I push regularly are lasix, soumedrol, vasotec, dilaudid. I am mostly concerned with the PRN BP meds.

    Also, do you always dilute w/ NS? Thanks!
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    Joined: Jun '08; Posts: 142; Likes: 197


  3. by   Dimple58
    Most meds book list the appropriate time for these drugs. You need to start a list and look them up. Laminate them and put them in your scrub pocket for reference. Don't depend on the hospital or pharmacy to tell you nursing things. Get a good drug book so you can show your reference. New nurses may know, older nurses may get it confused but the good book has it in black and white, keep it in your locker.
  4. by   CathyLew
    yep, I agree with glolilly... I would not take someones word for it. How do you know they are doing it right? And each patient is different, as is each situation. In an emergency, you may see people slam meds that normally they would give slower. BP meds its better to err or the side of caution. You can always give more if you don't get the right response, but you sure can't suck it back out of the patient if you get a bad response!
  5. by   ChristineN
    Always look up or call pharmacy about any IV push med you aren't available. Also, a pt's response can determine if you slow down/speed up. For example, I've had pt's that become hypotensive to IV push narcotics, so I've been known to push over 2-3min if it helps prevent the pt from becoming hypotensive.

    Things like Protonix or Solu-Medrol can be pushed faster. BP meds and Lasix I tend to do slower (I seem to remember a rule from nursing school being for each 10mg of Lasix take 1 min to push).

    Also, the type of line you are pushing into can matter. A 24G peripheral can not have things pushed into as fast without burning or irritation as compared to a central line.

    Oh and I always dilute IV narcotics and sedatives in NS. Zofran technically isn't supposed to be diluted, and some BP meds can work slower if diluted.
  6. by   Esme12
    No one should EVER give any drugs without looking it up to see what and how to give it. Giving certain drugs inncorrectly cause cardiac arrest. Lasix can cause ringing in the ears.......gentamycin deafness and redman syndrome (they patient looks suddenly sunburned) call pharmacy to check the drugs as they do know how fast or slow something my be given. Your hospitals/facility I am positive has policy and procedure books including approved meds and how to give them. Get to know your policy's and procedures.

    Ther are many drug pocket books and apps for your phone. a great company that I have used is micromedex. But your still have to act WITHIN your facilities policy and procedures.

    A good rule of thumb....the only drugs given IV fast is atropine, adenosine and epinepherine. The rest are slow over at least 2-4 min. Whether or not to dilute goes back to policy and procedures of your facility.

    There is not a simple answer just remember. Giving a drug IV the response is instantanous and you can't suck it back be very sure it's correct the first time.
  7. by   LDRNMOMMY
    You have been given good advice.
  8. by   steelcityrn
    Yes, very good info. I only know of a few drugs in a critical crisis that are pushed very fast.
  9. by   0402
    We have a chart in the med room, that the pharmacy puts out, that has many IV drugs listed, if/ how to dilute them (and with what, if it needs to be) and how fast/ slow to push them. It also has any other requirements for those IV drugs listed, I believe- like pt being on tele to if getting IV metoprolol. It's a great resource.
  10. by   anonymurse
    Easiest to find push rates in the IV drug book--there ought to be one in every med room!

    A few IV drugs aren't recommended for dilution by NS; Solu-Medrol is one.

    Another IV issue is filtration to block potential precipitants; e.g., amiodarone has to be filtered at certain concentrations but not others.
    Last edit by anonymurse on Mar 4, '11
  11. by   MassED
    refer to a drug guide.... you learn this in nursing school - instructors don't let you push any med (Or give PO meds) without stating what it's for, how fast to push it, side effects, dilution, etc.

    Just weird that a nurse is asking this....
  12. by   deemalt
    Thanks all for your wonderful advise. I think it's great that there are so many experienced nurses willing to share their matter how "weird" questions may seem to some.
  13. by   sunflowergirl14
    Student nurse correct me if I'm wrong. But I thought we are suppose to check the drug formulary to get the time to push the drug and whether or not it can be diluted with NS.
  14. by   Faeriewand
    We have a binder of listed meds that tells how long to push and if to dilute with NS or not. I was shown the binder in my preceptorship as well at another hospital so I assumed all hospitals had them.