Diluting medication by pushing through a distal IV port

dudette10, MSN, RN · Jul 10, 2014

There are about 20 mls in primary IV tubing. I believe you can look up the exact amount on manufacturer's websites. It may even be on the packaging.

The more important question is why she wants it to be diluted and why she is delaying the medication from entering the bloodstream? You also don't mention the medications she is doing this for. If the tubing distal to the port holds 15 mls, and the IVF rate is 100 cc/hr, it will take at least 9 minutes for the medication to even begin to infuse and longer than that for the entire dose to be infused. Why would she want that, especially in the ED (although I would question it in any setting).

Been there,done that, ASN, RN · Jul 10, 2014

It does not matter how many milliliters are in the IV tubing. Pushing any medication this way will not allow for a time controlled IV push.

Dilute the medication according to the recommended standard, then push over the recommended time frame.

The assisgned RN is either lazy , misinformed, or both.

OCNRN63, RN · Jul 10, 2014

This is how many of us in the ED would give IV phenergan back in the day.

MunoRN, RN · Jul 10, 2014

It's probably less accurate to dilute meds this way, since it takes more diligent calculating, timing of injection, etc. I usually pre-dilute but then put the push dose into a port, moving the beginning of the push dose all the way up to the patient using a flush (this requires knowing the volume between each port on the tubing and the patient), this makes for no delay in the patient starting to receive the dose because the dose is way up the tubing.

Lev, MSN, RN, NP · Jul 10, 2014

If I give meds through the IV port, I will pinch back the tubing at the port site so it doesn't flow up, push in the med, and then flush with 10 ccs to push it into the vein.

MunoRN, RN · Jul 10, 2014

If I give meds through the IV port I will pinch back the tubing at the port site so it doesn't flow up, push in the med, and then flush with 10 ccs to push it into the vein.[/quote']
Pinching the line above the port has become a redundant habit with the IV tubing typically used today since they have a backflow stop. The pump adds another backflow preventer. You'll notice when pushing through a port on tubing that if you've forgotten to open a stop-cock down stream, for instance, that you won't be able to push at all, even without pinching above the port, if there weren't backflow preventers you wouldn't meet any resistance since it would just backflow to the bag.

libran1984, ASN, RN · Jul 11, 2014

Most IV fluids I give in the ED are WO. I'd imagine it'd be in the system in less than 10 seconds with sub-optimal flow and a 20G or larger Angio.

Personally, I believe all meds should be given at the most proximal hub without disconnecting the fluid bolus.

If I want my meds to be "Diluted" I will combine with a 10mL syringe of NS and then push slowly. When I was younger, I would occasionally do as ur preceptor did and push at the most distal hub. As an end result tho, I think it is poor practice of the inexperienced or young... As I say this with only 4 yrs under my belt! Lol

MunoRN, RN · Jul 11, 2014

Most IV fluids I give in the ED are WO. I'd imagine it'd be in the system in less than 10 seconds with sub-optimal flow and a 20G or larger Angio.
Personally, I believe all meds should be given at the most proximal hub without disconnecting the fluid bolus.
If I want my meds to be "Diluted" I will combine with a 10mL syringe of NS and then push slowly. When I was younger, I would occasionally do as ur preceptor did and push at the most distal hub. As an end result tho, I think it is poor practice of the inexperienced or young... As I say this with only 4 yrs under my belt! Lol

I'd say the port that should be used is dictated by the volume of medication you are pushing. Lets say the port closest to the patient has 4ml of volume between the port and the patient (between the port and where the fluid enters the bloodstream). If you are pushing 2ml worth of med then that port works fine; you can push that med into the line as fast as whatever is ahead of it in the line (typically NS) can be safely infused, which is about as fast as you can push a plunger. You could flush the port with another 2 ml and now the first part of the med is at the tip of the line and will infuse at the rate of the NS in the line.

If you're pushing 8ml of medication however and you insert it into the line at that same port, then only the last 4ml will infuse slowly, the first 4 will get pushed in quickly by the additional 4ml behind it. In this case I would usually use a port farther up, say with 10ml between the port and the patient, and then push it forward to the tip with a 2ml port flush.

calivianya, BSN, RN · Jul 12, 2014

I don't do that to dilute, but if I'm in a huge rush and have to give something that is going to take forever to give, like a huge dose of IV Lasix, I will put it at the most distal port from the patient. I will then program in a 10cc saline "piggyback" to come out of the primary bag (only if it is straight-up NS or 0.45 NS and only if there are no additives like potassium, etc.), and run that 10cc piggyback at 60ml/hr or so. 60ml/hr gives you 1ml/min, which would push in 4ml of Lasix over 4 minutes once the Lasix gets to the patient. That is a safe rate for Lasix, and better than rushing myself if I really have to get out of the room right then for some reason. Obviously, setting a piggyback is unnecessary if you have fluids running at a decent rate, but if your fluids are only KVO programming in a 10cc piggyback lets your patient get his meds in a reasonable time frame. An entire line of IV tubing might take 20ccs, but I very seriously doubt it takes more than 5ccs, if that, to get from the second farthest port from the patient to the patient with the tubing we use. Are we counting the contents of the drip chamber in what it takes to prime IV tubing? That makes a big difference in the amount of volume we are talking about.

Loo17 · Jul 12, 2014

Hello all, I am an intern working in the ED and my assigned RN gives push medications through a distal IV port with NS running. The rationale being that the medication is being diluted in the NS flowing through the tubing. I have two questions that I have not been able to find answers to.
1. How many milliliters are actually in IV tubing
2. Is this practice evidence based (I have been searching journals and cannot find anything on the topic)

Is the normal saline running wide open or at a set rate via an IV pump? I give my push meds through a port this way but only when the fluids are running wide open.

BrnEyedGirl, BSN, MSN, RN, APRN · Jul 13, 2014

I do this if I want to push something very slow, for instance Fentanyl 50mcg to an elderly hip fx,...I dilute the med in a 10cc flush then use a proximal port with w/o NS and push slowly then may even refill the syringe with NS a few times while pushing. This is NOT to dilute something that should be given in 100ml,..this is a personal preference that allows me to give the med very slowly and even monitor my pt while I'm pushing. I will especially do this if my pt voices concern about "such strong meds",..it allows me to go very slowly, and spend 8-9 minutes with the pt monitoring their response.