Do you look up the push rate for IVP meds?

[Nsco2018]

In school, we're taught to ALWAYS look up the push rate of an IVP and always go by that. But in clinicals, I've had people tell me they really don't do that unless they're serious meds (pain meds, digoxin, etc) and even then, they don't go at a certain rate.. they just go very slow. What is the general rule of thumb??

[PeakRN]

If you are not familiar with a medication you should be looking it up. Many medications have greater side effects when pushed quickly, even ones that you may not consider 'serious' medicines like reglan for example.

[JKL33]

I tend toward being a by-the-book-er on stuff like this, meaning I use the recommendation as my guideline. If something is completely new to me, yes I look it up.

I've seen enough patients have very uncomfortable (though probably not dangerous) reactions r/t people pushing stuff super fast through SLs. One person sat bolt upright and began vomiting repeatedly and HR increased 50 bpm within a minute of being practically slammed with one of the most common things we give in the ED (not narcotic related, and not adenosine ). Then there are all the other people with itching or burning or a "red streak" at the IV site related to rate of administration, etc., which often enough they translate as being allergic to something. There's no need to be OCD about it, but being ignorant or bada$$ rogue about how one pushes medications can have a few consequences even for "non serious" medications.

[Guest219794]

I tend toward being a by-the-book-er on stuff like this, meaning I use the recommendation as my guideline. If something is completely new to me, yes I look it up.

I've seen enough patients have very uncomfortable (though probably not dangerous) reactions r/t people pushing stuff super fast through SLs. One person sat bolt upright and began vomiting repeatedly and HR increased 50 bpm within a minute of being practically slammed with one of the most common things we give in the ED (not narcotic related, and not adenosine ). Then there are all the other people with itching or burning or a "red streak" at the IV site related to rate of administration, etc., which often enough they translate as being allergic to something. There's no need to be OCD about it, but being ignorant or bada$$ rogue about how one pushes medications can have a few consequences even for "non serious" medications.

Compazine?

[JKL33]

Well I imagine that wouldn't be great either, but in this case it was run-of-the-mill SoluMedrol.

[cleback]

Yep. Eventually, you will come to memorize the ones that need special attention (eg giving Lasix too fast can cause tinnitus).

[blondy2061h, MSN, RN]

Our Mars say how long to push it over and sometimes I ever loosely obey it

[KelRN215, BSN, RN]

In peds, we tend to run EVERYTHING on a pump. Even a medication that the pharmacy has labeled to administer over 3 or 5 minutes is typically administered via syringe pump. The MAR and the label on the syringe tell how fast to infuse it. The recommended infusion time is also available on the hospital's online formularly. When I was a staff nurse, pretty much the only meds we actually pushed were toradol and ativan for actively seizing children.

[Meriwhen, ASN, BSN, MSN, RN]

Yes, yes I do.

Granted, I don't have a lot of them to give, so I don't get a chance to get very familiar with them.

[Ruby Vee, BSN]

I've worked in ICU for 35 years, and I look them up. I know the push rates on the drugs I give often, but if I'm not sure of the push rate, I'll look it up. When I was new, I had a little notebook in my pocket and I looked up the drugs and then wrote myself little notes. At first, I was looking up every drug, but gradually I became more familiar with them and didn't have to.

Not long ago, a student told me that she had learned we could just slam Lasix in. That was the "latest recommendation." You can bet I looked that one up and showed her where to find the IVP list and how to use it. Turns out that wasn't the latest recommendation. When your facility specifies how fast you can push a drug, that's how fast you push it.

[jive turkey]

In school, we're taught to ALWAYS look up the push rate of an IVP and always go by that. But in clinicals, I've had people tell me they really don't do that unless they're serious meds (pain meds, digoxin, etc) and even then, they don't go at a certain rate.. they just go very slow. What is the general rule of thumb??

At your current stage of practice it is necessary for you to do things and think in terms of by the book. Learning and thinking in terms of best practice and falling short of it in the real world is better than learning and thinking in terms of decent practice and falling short of that.

What's more important than the push rate is the patient, their condition, and potential adverse reactions/side effects of the medication regardless how fast or slow it is injected.

[osceteacher]

Kind of, not always. I think because we predominantly have juicy CVC lines we feel we can bang them in at a rate we like, I tend to avoid this with drugs like furosemide and dig etc but I think we have a tendency to be more liberal with our rates, although I would never advocate this and I'm definitely more conservative than most.

I think this kind of thing happens a lot on the wards, I doubt you'll get a nurse giving Augmentin over 3-4 minutes for example, in fact I know they don't. I think we're a little lax on things like this in the NHS.