Best way to administer low volume IV meds to micro preemies

[aepoisson]

Out unit is trying to find the safest and easiest way to give IV meds to micro-preemies. We want the baby to get the IV medication in the prescribed time but have a few constraints. We leave all our medication tubings attached to our main IV lines. We just keep giving meds on the line and flush after each. Twice a week all of our lines get changed completely (CABSI stuff). We are not allowed to add any extra volume to our prepared meds. Pharmacy has to do it under a hood (infection concerns). We have to use our syringe pump libraries to give IV meds and cannot bypass it to give volume over time or push in IV meds. Right now, our nurses have been doing their own thing and we would like a consistent way to give IV meds, especially those with low volume. We want to ensure that the med gets to the baby in those 15 or 20 minutes and hasn't been left way up in the IV line or flushed in in 2 minutes instead of the 20 minutes. Thoughts?

[babyNP., APRN]

What we do is run the med in the normal time and then our pumps ask us if we want to flush, we say yes, and then how much (usually 0.6mL-1mL) flush and then it automatically calculates the rate at which it should go based on how long the medication rate was. Our pumps have a library on them that calculate how long each medication is supposed to go in and gives you a range to choose from.

[Kristen, NICU RN]

If you have to give a med and the med volume is only 0.1cc for example... you would count up the amount needed to actually get to the baby (the end of the IV catheter, UVC, UAC etc). So say your baby has a UVC with a med line and 1 stop cock. You would add up the med tubing (.3cc) the stopcocks (.2cc each) and the length of the catheter (.2cc for a UVC)... that equals 0.7cc of tubing before the med even reaches the baby. So what we do is slowly give the 0.1cc of the medication, then attach a 10cc NS flush and give an additional 0.6cc of NS. The medication is now at the tip of the catheter just before the baby. Then the pump is programmed to deliver the medication over the specified time.

If I had a larger medication volume say 1cc and my baby had a UVC with 1 stopcock and med line ... (0.7cc total) Our policy states to slowly push in 0.7cc of the medication. At this point the medication is at the distal end of the UVC. My med syringe would still have 0.3cc of medication in it. I would then load the syringe on the pump and program it and start the infusion. When the pump alarms "syringe empty" I would then get a 10cc NS flush attach it to my med line and the press "continue."

Hopefully that makes sense. We just received a new policy about medication administration because we found nurses all had their own way of doing things. This is supposed to be our universal practice.

[wooh, BSN, RN]

I think the long explanations boil down to this: Put the flush on the pump at the rate the drug is supposed to go at.

[NicuGal, MSN, RN]

Our pumps are set to continue to deliver at the same rate when we hang our flush.