IV push meds

[IngyRN]

These may be stupid questions.......

We give IV push meds all the time. So for example 4mg of morphine=1ml. We push this through a PICC over 1 minute. since the catheter is so long aren't we really just pushing it slowly though a small length of the catheter? Then we flush w/10cc NS-but isnt the flush really what will push the med though-should we be flushing over a minute as well?

Also if you are pushing through a running IV, if you pinch the line, arent you just injecting his thru the length of the tubing-isn't the med not really infusing until the running IVF is infusing??

[RedhairedNurse, BSN, RN]

I do my flushes slow because that is when the drug is really felt, so the answer to your question IMO is yes.

And yes on the other question, the drug will not reach the pt unless the IV fluids are running or unless you flush it.

I'm a new nurse, this is just what I'm thinking is right, I could be wrong though, so I look forward to seeing other posts on this subject.

[BinkieRN, BSN, RN]

These may be stupid questions.......

We give IV push meds all the time. So for example 4mg of morphine=1ml. We push this through a PICC over 1 minute. since the catheter is so long aren't we really just pushing it slowly though a small length of the catheter? Then we flush w/10cc NS-but isnt the flush really what will push the med though-should we be flushing over a minute as well?

Also if you are pushing through a running IV, if you pinch the line, arent you just injecting his thru the length of the tubing-isn't the med not really infusing until the running IVF is infusing??

I'm not sure I understand the question????

Whether you are pushing IV medications through a peripheral IV, central line or PICC line the protocols are the same. Follow the IVP dilutions and push rates in the PDR or ask the pharmacy

[RazorbackRN, BSN, RN]

I understand what you're asking and you're correct.

If you have access without fluids infusing, when you push a small volume med through the t-connector (or whatever tubing that is connected to the hub of the cath), it is going to stay there -until you flush it. The flush needs to be slower because at that point you are flushing the drug out of the tubing into the vein.

However, if it is just a t-connector, which is just a 6in extension, the volume of those are less than 0.5 ml, so push accordingly.

[sam20007]

I believe the question is why we still asked to push slow while the drug will not go through till the fluid will run, or we flush the NS?

I think I find it a good question not stupid I wish someone will answer it.

[3rdcareerRN]

These may be stupid questions.......

Actually, I think these are perfect examples of the critical thinking that all nurses should be doing, and not stupid at all. On behalf of all the nurses who will read this thread in the future, thank you.

(P.S.--I do not have an authoritative answer.)

[BelleKat, BSN, RN]

Here is a rule of thumb;If you're pushing a drug through a running IV and you do this sometimes,push it SLOWLY. If you crimp the tubing and flush before b/c the med is not compatible with the hanging IV then put the med in then flush SLOWLY. If you put the med in a Saline lock or HL then flush before to check patency,instill medicine then flush SLOWLY. There are very few meds that you can give quickly,you need to check each and every one because some like Vitamin K or Dilantin cannot be pushed quickly or cannot be mixed in certain IV solutions.

Always check the PDR(micromedex) or call pharmacy before you give a med IV for the first time. Remember when anything is pushed through the IV especially central lines but in any patent IV they are introduced into the circulation immediately and if the pt is going to react,they will react more obviously to something entered quickly.

[PICNICRN, BSN, RN]

"We give IV push meds all the time. So for example 4mg of morphine=1ml. We push this through a PICC over 1 minute. since the catheter is so long aren't we really just pushing it slowly though a small length of the catheter? Then we flush w/10cc NS-but isnt the flush really what will push the med though-should we be flushing over a minute as well?"

YES.... the PICC cath probably holds more than 1cc of fluid- you can check the info packet for the cath which you probably keep in the pts chart. So, yes! You should push your flush slowly.

"Also if you are pushing through a running IV, if you pinch the line, arent you just injecting his thru the length of the tubing-isn't the med not really infusing until the running IVF is infusing??"

YES! You in fact are just pushing the first 1cc of IVF in the line into your pt. So.... you should either follow this up with a slow flush, or not crimp the tubing so that it flows in with your fluid- if your IVF is not infusing at a high rate.

[iluvivt, BSN, RN]

Your thinking overall is correct. keep in mind that the priming volume of a PICC line is very low. For example,the priming volume of a 4Fr Groshong PICC is about .4 ml. So if you give .5 ml of a med directly at the site,it will still be sitting in the PICC. You should always take the priming volume of a line into account so that you can follow push meds with a slow flush consistent with the needed rate of the medication you are giving. Instead of memorizing all the priming volumes of lines just remember that a port will be the highest at approx 2.5 ml and a PICC will be about .4-.6ml (depending upon the size). All others ( ie percutaneously placed CVCS in the IJ or subclavian will be approx 1-1.5 ml. This does not include any add-on. So if you give at a y-site of a primary line you need to add more to clear the line. After your slow flush remember to do a good pulsatile flush on all CVCs

[UM Review RN, ASN, RN]

This is why I dilute and push slow.

[zoo*moon, BSN, RN]

right, if you have a long line, the med you are putting in (e.g. morphine) has to clear the line first, so when you flush with saline, also go slow-- look and see how far before it reaches the patient. if iv fluids are compatible they can carry the drug in (after you release your pinch) but can take too long depending on the rate and where your port you used was on the line.

also, when using a picc or any central line, be sure to use no less than a 10cc syringe. our pyxis dispenses morphine in prefilled syringes so these have to be transferred to a 10cc. less than 10cc is too much pressure for central lines.

these may be stupid questions.......

we give iv push meds all the time. so for example 4mg of morphine=1ml. we push this through a picc over 1 minute. since the catheter is so long aren't we really just pushing it slowly though a small length of the catheter? then we flush w/10cc ns-but isnt the flush really what will push the med though-should we be flushing over a minute as well?

also if you are pushing through a running iv, if you pinch the line, arent you just injecting his thru the length of the tubing-isn't the med not really infusing until the running ivf is infusing??

[IngyRN]

Thank you all for your responses. It was really helpful.I am orienting right now after being out of bedside for a long time. Back then, we would dilute the med either to make a total of 10cc, or mix it in a 50cc bag and infuse quickly.

I am observing that now the RN pushes the med over X amt of minutes, then flushes the line at a regular flush rate. Also, with running lines, the line is pinched, med infused thru port closest to pt, flushed then IVF cont to run. Is 10cc enough to clear the line?

Sorry for the ??'s-I like to know how and why I am doing things for better understanding- I hate to just "memorize" the steps. Thanks again to all.

BTW-we are not allowed to dilute to make 10cc or add to 50cc if ordered IV push.