IV push question

[desertgal]

I'm new to the Emergency Department. We usually start an IV bolus wide open off the pump on most of our patients. I see a lot of nurses giving IV push medications and not pinching off the tubing above the distal port when pushing medications. I've asked several of the nurses about this practice, and they've told me as long as they have an IV that's working well they won't pinch the tubing. They slowly push the drug while the NS is infusing. This gives a slow, even push. My concern with this method is that the drug could back prime up the line.

On the other hand, if you do pinch off the tubing (like all the textbooks say to do) and are giving an undiluted drug, how do you control the rate of administration? Do you push a little, release the tubing, push a little? Are both methods considered acceptable?

I know there are other threads about diluting all IV push medication with NS so that the push can be better controlled. I hope this isn't a redundant thread.

Thanks!

[klone, MSN, RN]

If the site is patent and the maintenance fluid is flowing well, there's no reason to think that an IVP would backflow. The maintenance fluid would prevent that from happening.

I do not pinch off, because I like the dilution factor of the maintenance fluid when I give an IVP.

Besides, even if it did backflow, once you're done pushing it and the maintenance fluid is running again, it will all go right into the pt anyway.

[PAERRN20]

I pinch, push, pinch, push, pinch, push....just a little at a time.

[desertgal]

Thanks for the reply Klone. One more question. If you have your fluids wide open, is it necessary to flush in between incompatible medications. I always do, but is it necessary? Does the wide open fluid provide enough flow to flush the distal port free of the first medication?

[klone, MSN, RN]

I do flush, simply because the port is long enough that some of the medication will stay right there in the port.

[Hooked on ER]

I never pinch, the pressure coming from above pushing the fluid into the vein will be greater than the pressure you are using. I do flush between incompatible meds just because of the risk that some will stay in the port.

[azhiker96, BSN, RN]

I don't pinch but I do watch the drip as I push the med. If it's dripping then it's flowing.

[EmergencyNrse]

I know there are other threads about diluting all IV push medication with NS so that the push can be better controlled. I hope this isn't a redundant thread.

Thanks!

... It just doesn't matter. Go with what makes you sleep better @ night.

Me, I dilute whenever possible. Unless there is a fluid restriction just lett'er rip.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I don't pinch unless it something that needs to go in fast,...then I pinch and push at the closest port,....most routine meds I don't pinch and I use the port closer to the bag, because as someone else said I like the dilution factor,..I push a bit then let it run a bit, push a bit etc,....and if I do it this way then no I don't bother with a flush as the line is being flushed with the fluids,..you could always draw from the bag and flush if it really bothers you.

[simboka]

Back priming's not a concern for two reasons: the pressure from the fluids will push it in, especially if the bag's high and wide open; or when you finish the fluids will flush it. I've given colored pushes through free flowing fluids, and it's not gone up any significantly up. Our tubing does have a one way valve below the main bag of fluids.

Definitely need to flush between, we actually just had an inservice by some tubing people, and she said up to 0.1mL can stay in a luerlock port on tubing.

[LETRN]

If you've got a good line in and the fluids are going in quickly, I don't think it's necessary to pinch it while pushing the med...I never do. I give it from the highest hub in the line and push it in slowly.

[shiccy]

The IVP med physically cannot go up many lines. If you look at your IV tubing, it should have an antireflux valve. What I'm saying is you should have a valve that PREVENTS the med from at least reaching the IVF bag. Even if it WERE to get all the way up to that valve, it would stop there. Once you stop pushing the med, if you have the IVF wide open then your med will eventually infuse with the wide open solution (that is, if it's actually infusing).

I *do* pinch the line, but that's because I NEVER run ANY IVF's free flow. I live in the ICU world, so NOT having a super accurate I&O is blasphemy for me If you DON'T pinch the line and the IVF are on a pump, you'll set the pump off by saying, "Error occlusion" because you're putting back pressure in the system. If you pinch it, you don't have this problem.

Finally, in YOUR world, I would think this free flow/IVP system would work really well and have a nice controlled rate of getting a med. That being said, in YOUR world, I wouldn't think pinching would be needed. Also, you need to follow your formulary direction for IVP meds. If you're suppose to IVP Lopressor 5mg over 2minutes, stick with that. Some places do 2-5 minutes. Others do over 5minutes. Know your rules and push slow ... unless you're in a code situation, then GO GO GO!