Getting the needle in the vein...

Are you using a butterfly type steel needle or just a regular 20 or 18 gauge needle? I have some ideas for you but I would like to know the product you are using so I can be more specific. I suspect you are NOT using an IV cannula of some type. Also what IV medications are you administering?

Sometimes it is safer and easier to just put in an IV. I do find it difficult to put for instance a butterfly needle into someone's vein and leave it there to administer a med. A 22 or even 24 gauge IV would allow you to secure the device so that you are not apt to have infiltrate. And it flushes easier, so that you are sure they get all of the med. And you can draw labs off the line if you need to as well. If you are using just a straight needle, without the ability to "draw back" on the line, I would not think it safe practice to not assure placement prior to pushing a med. And a smaller gauge IV (or heck, even a 20 gauge if that is what you need) would allow you to do this.

We generally use a 25 gauge needle, and it is not a butterfly. We push a mixture of demerol, zofran and normal saline-usually a total of 5cc. It's a regular syringe as well...

Most likely you are not securing the needle in fashion that allows the needle to gently rest within the vein without pressing against the vein wall. Having the needle actually resting against the vein wall can cause the needle to puncture the vein causing infiltration or infusing at a high rate can cause a jet of infusate to actually cut through the vein. High concentrations of medications can be very caustic and damaging to the vessel wall. If you are mixing demerol, zofran, and saline within a volume of 5ml then your medication is VERY concentrated.

As a rule of thumb I do not push a medication without diluting the medication into a 10ml syringe and I only place a single medication into a single push. Generally, each push should take at least a minute to several (depends highly upon the medication and what it is administered for). If it is not taking you several minutes to administer then you are pushing a bit fast. 4mg of Zofran itself should take 2-5 minutes and demerol should take 4-5 minutes.

are you sure you are allowed to do this as an LPN? this sounds an awful lot like an IV push to me.

are you sure you are allowed to do this as an LPN? this sounds an awful lot like an IV push to me.

1. I'm an LPN, work in an ED, start IVs and push more meds in a day and rarely see the likes of PO meds.

2. Giving any med str8 to the vein is IVP and in my opinion, is most effective/safe when administered through a secured saline lock- especially in those jittery ptaients.

Maybe it varies state to state, but I didn't think LPNs were allowed to do IVPs anywhere. I've only worked in Ohio and PA. Interesting...

Some states are more lenient on this than others. Some facilities are expanding the role of the LPN more readily. A number of state practice acts essentially say that it is up to the facility what in the LPN's practice they will allow. Massachusetts? No way. (and I dunno there may be a facility in MA that allows this, however, I have not heard of this in this state). And I do think the OP is taking a HUGE risk, LPN or RN in injecting a med from a straight needle into a vein when there is no safety net to insure the needle is in the vein. Putting in an IV would be no more of a poke, can ensure placement, and flushing. But as ionatan pointed out, it is very unusual for an LPN to be allowed to do IV pushes. So I would really see on my state practice act if this is allowed, or in your LPN policy of the facility you work for. It is all fun and games until something happens after you push a med and THEN you find out that it was not within your scope to be doing it to begin with. (and people suddenly develop amnesia and had not a CLUE that you were doing it this way....) Protect your license and get informed. And I also float to a busy ED. I can do many things, but pushing meds is not one of them. Just for my own protection, I would really, really, look at if an LPN can push meds......

Thanks for all the input. I myself would much rather just place an IV rather than doing it the way we currently are, but they have been doing it this way for years here. I understand all the concerns about an LPN doing IV push, but like others have said, it varies greatly from state to state and even facility to facility. There is another LPN working in the clinic where I work, in fact, her and I are the only two nurses. She has been working here for 6 years, and this is the way things have always been done.

WldChrry, just because it has always been done that way does not mean that it is right. You are responsible for knowing your scope; you would be wise to get a copy of your facility policy and your state's scope of practice, and keep thee documents on file somewhere so that you can cover your derriere if need be.

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your scope will include skills that the facility train and allows an LPN to do. If they certified you to perform it, then you must be competent to do that skill?

I agree with just because something has always been done that way, doesn't make it right as far as the safety of the patient. If there's only 2 of you, perhaps approach the MD and ask it you could do IV placement instead? Otherwise, it is just not good practice, and not safe for the patient. Even a butterfly has some flashback, although unless anchored well, can penetrate the vein as you are pushing. If you find out that it is NOT within your scope to push meds, you could research putting the med to be "pushed" as a secondary on a pump so that you know the med is going in at the correct speed, with a saline flush after for the patient to receive the full amount of medication. Or a syringe pump. If one is a certified medical assistant, they have lee way as far as the MD taking licenced responsibility for anything they train them to do in their own practice/clinic. As a licensed nurse, you would take the fall for a poor outcome. And it would be a really hard sell to say that "it has always been done this way" as the reasoning behind a not so safe practice that would cause a patient harm.