Zofran: IV push or Piggy Back?

Specialties Oncology

Published

Specializes in Tele Step Down, Oncology, ICU, Med/Surg.

I was taught by my experienced preceptor that any amount equal to or over 8mg of Zofran needs to be injected into a 50ml bag (D5 preferred but NS OK if pt is diabetic) and hung as a piggy back; however, after working on the unit for awhile I've come to realize that every nurse does it differently.

Some nurses draw up 4mg of Zofran into 10cc of NS. If they are giving 8mg they just push two syringes instead of one, followed by 10cc of flush, others just draw up all 8mg straight up without dilution and push slowly bumping up the primary infusion fluid to 100cc for the brief time they are at bedside.

I was wondering what is the "right" or "best" way? Maybe one doesn' exist as I've researched this and haven't found any.

How do you do this?

Thanks, TR

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Specializes in Oncology.

Don't have my drug book at home, but all the online literature I could find said that 4mg could be pushed undiluted, but must be given over 2-3 minutes. I dilute mine in 10cc.

According to the online lit, all doses over 4mg must be given in 50cc over 15 minutes. I recommend always going with what the literature says to keep yourself safe.

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Specializes in oncology.

I'm not sure how many 50cc bags of NS we'd go through on our floor if we diluted > or = 8mg zofran w/each administration. You can safely push it directly - undiluted or not - over a couple minutes. Just remember the side effects: dizziness being a biggie, so keep that in mind w/pt ambulation, etc.

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Specializes in Oncology, ID, Hepatology, Occy Health.

Agree with nursie pants that it can be pushed, though most of my colleagues use the 50cc bag option.

I think we need to be careful of overload with patients on multiple products hanging bags for everything we give - especially haematology patients on multiple anti microbial agents, plus chemo plus anti-emetics plus steroids plus blood products etc. etc. all on top of a base infusion. Sometimes we add litres to their intake before we know it, hence I'm all for IV push whenever it's possible for a particular product.

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Specializes in Oncology, Med-Surg.

If the oncologist orders it as a premed for chemo, the pharmacy at my hospital puts the Zofran 8mg in a 50NS bag. I feel better to have it this way because if I am in a hurry I would hate to wait 2-5 minutes to push something...

Speaking of anti-nausea meds push time, How about for Phenergan 12.5mg or Reglan 10mg. I see people put it in a 50NS flush, but I thought I read some where was ok to push.

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If the oncologist orders it as a premed for chemo, the pharmacy at my hospital puts the Zofran 8mg in a 50NS bag. I feel better to have it this way because if I am in a hurry I would hate to wait 2-5 minutes to push something...

Speaking of anti-nausea meds push time, How about for Phenergan 12.5mg or Reglan 10mg. I see people put it in a 50NS flush, but I thought I read some where was ok to push.

I know for raglan 10mg and below can be pushed. Anything above should be hung

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Recommended dilution for Zofran is 1:2. 50ml bag seems excessive. I work in pediatric oncology/BMT where you can't afford to use large amounts of fluid. So we usually dilute it in a 10ml syringe. Zofran can be pushed. However if its given around the clock, we run it over 15min which is the intermittent infusion recommendation.

Someone mentioned Reglan. Low dose Reglan (0.1mg/kg) can be given without Benadryl. However if you are using 1mg/kg, should be mixed with equal amount Benadryl to prevent extra pyramidal reaction. And Benadryl shouldn't be pushed in general.

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I work in a very busy ER. Zofran 4-8mg is routinely ordered. I push it over 2-3 min in a 10cc syringe. 5cc if it's a Paediatric pt. Followed by a minimum 3 cc flush. Sometimes 10 if I have one in my pocket. I've never had issue w this method. I use the same process for Reglan 10 mg. However; "back in the day" it was customary to use a 50cc IVPB for Reglan. To the Nurse who suggested pushing Phenergan IV, please be sure your IV is well placed, in a LARGE vein and at least an 18G. Extravasation of the periphery is a nasty thing!! I advise ALWAYS diluting Phenergan yes, even 12.5mg unless you're utilizing a central line. Benadryl IVP will cause bronchospasm if pushed without dilution and too quickly but it can be administered IVP. Best practice; check with your Pharmacy, know your Hospital's Policy and Procedures and departmental protocols. What works in an ER may not be feasible in an ICU

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I work in heme/onc and have never mixed my own bags. If the dose is 4 mg, we draw it up in a syringe, but anything over that is made by our satellite pharmacy.

By my personal choice, I always push all my IV pushes over at least 2 minutes. Yes, I am willing to take the time to do this.

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Specializes in Psychiatry, Oncology.

One of our most frequently given medications. Our pharmacy instructions say "undiluted over 2 minutes". I trust they have evidence behind it.

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Specializes in Psychiatry, Oncology.

By my personal choice, I always push all my IV pushes over at least 2 minutes. Yes, I am willing to take the time to do this.

Me too. And usually add a little extra time to what is recommended by practice/pharmacy guideline for good measure:)

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Some hospitals push 8mg still but I say why risk it....

Clinical Pharmacology states:

"Intermittent IV Infusion:

  • For doses more than 4 mg and for chemotherapy-induced nausea and vomiting
    (CINV), dilute to a maximum concentration of 1 mg/mL in 5% Dextrose Injection or
    0.9% NaCl Injection.
  • Infuse IV over 15 minutes.
  • Storage: Dilution is stable for 48 hours at room temperature."

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