IV push

[greyL]

In school I was taught to dilute IV push medication with saline, but my preceptors have told me this isn't necessary. Which is correct? Also, the couple of times that my preceptor has been with me while pushing meds, she made me feel rushed! How much time do you need to push narcotics and things like protonix? =/

[CodeteamB]

Having been on the receiving end of a burning "slow" IV push I will say that I'd dilute everything and push SLOWLY! I was on a saline bag, dehydration due to hyperemesis, and I don't remember if it was Zofran or potassium (probably potassium) but the IV push burned so badly that I was in tears.[/quote']

Who on Earth would push IV potassium?!?

[Altra, BSN, RN]

I feel very comfortable saying that I don't think potassium was given IV push to T-Bird78, as s/he is here having this conversation with us.

[Beverage]

I dilute many meds in 5ml NS. Dilaudid comes in 1mg/1ml carpuject and sometimes a vial. order is for 0.5mg. I draw up the .5ml and dilute it for easier pushing. 1/2 ml barely clears the SL and the flush slams the concentrated med in patient. Some of my med seeking pts ask for a fast push, I make sure they get a healthy dilution. I'm here to ease your pain, not give you a desired head rush. Our EHR MAR has recommended push times in the instructions.

[Anna Flaxis, BSN, RN]

To the OP, your facility should provide you with a drug guide, either as a book located in the med room where meds are drawn up and prepared, or as an online resource that you can access prior to administering any medication. The drug guide states whether a medication should be diluted and gives the rate of administration. Taking a few extra minutes to consult the drug guide prior to administering a medication is never a waste of time.

Do not let yourself be pressured into administering any IV push in less than the recommended rate. Should an adverse reaction occur, that you felt pressured by someone else to go faster is not a defensible rationale.

As has already been pointed out, using a smaller size syringe to administer a small amount allows for a slower rate of administration. Also remember that the first 2-3mLs of the flush following the med should be given at the same rate of administration as the med. This allows for the med to clear the extension set at the appropriate rate, instead of being pushed through as a rapid bolus.

[ayla2004, ASN, RN]

Evidence is king our pharmacy issued guide to injectables is a ke resource to provide safe pratice for yourself and to back this up if a colleague or preceptor

[a4n6nurse]

My practice area is pediatrics. In some cases meds need to be diluted for their fragile veins. (IE; Dextrose is given as D25, not D50-Bicarb is also diluted) In other cases we are giving many meds and don't want to over due fluids just for dilution. Many narcotics are diluted to negate "whimpy white boy syndrome". If I don't know dilution factor for a certain medication I look it up! (IE; 50mg/ml, 250mg/ml) Our formulary lists best practices for all-from evidence based research. I admit when my practice was primary adult I was more lax. So the point of this long rant; some things are diluted-some are not, but I have a reason for each way I do it.

[Been there,done that, ASN, RN]

Many meds can be given without diluting. I find this reply very odd.

IV push medication is administered over the amount of time that was ordered.

I feel that any medication needs to be diluted , in order to administer it over the prescribed time frame.

[MunoRN, RN]

IV push medication is administered over the amount of time that was ordered.

I feel that any medication needs to be diluted , in order to administer it over the prescribed time frame.

Why does it need to be diluted to give it over the time frame?

[FineAgain]

I don't dilute as much as I used to...but if I haven't given something before I look it up. Some medications can't be diluted - like valium! Causes crystals to form.

[RNsRWe, ASN, RN]

wow, I had NO idea there would be such controversy over this topic!

My two cents--I was taught to dilute any med that was drawn straight into a syringe, as the only reasonable way to give a tiny amount (as these are often .5ml, 1ml, 2 ml) over the accepted period of time would be to put it in enough solution to make it possible--or, maybe better said, practical. My clinical settings, and the hospitals I eventually worked in, typically had 6ml and 10ml syringes on hand. Might have been others--of course the Big Guns-- but I know those were the "go to" ones.

We were taught that veins subjected to regular PRN IVPs, as well as stat IVPs, on top of scheduled doses, were more likely to become irritated. We were concerned with pain, and the likelihood of infiltration and extravasation.

I seem to remember the exception to this would be meds that have a higher volume per dose, such as 5mg of metoprolol being in 5ml volume. Not hard, then to do it over 5 minutes.

Carry on.

[VANurse2010]

IV push medication is administered over the amount of time that was ordered.

I feel that any medication needs to be diluted , in order to administer it over the prescribed time frame.

And you would be mistaken, particularly with meds that are not meant to be diluted.

[Anna Flaxis, BSN, RN]

IV push medication is administered over the amount of time that was ordered.

I feel that any medication needs to be diluted , in order to administer it over the prescribed time frame.

What about adenosine?