Giving small volumes of IV meds

[LittleMermaidRN]

Hello, I'm a brand new orienting PICU RN, and I find myself a little confused when administering small volumes of medications via syringe pump. For example, 0.4ml of Diamox to be given over 15 minutes. I know the med line holds nearly 2ml so the medication won't even reach the patient immediately. How would you administer this medication? I've seen nurses push it into the med line and then just run a flush behind it, so I'm curious what the standard is with tiny volumes administered on a pump. Thank you!

[MGMR]

You can see the actual amount each medline tubing is on the package before you open it. The ones we use are about 0.8cc, plus the very small amounts in the back check valves on either end (each being about 0.05cc maybe). So, if the medication is 1cc or less, we push that entire amount into the line and run the flush to deliver the medication over the correct amount of time. The flush is 1cc to ensure the entire line is flushed through.

[NotReady4PrimeTime, RN]

That's pretty standard practice. It's not perfect, but when every mL of fluid matters, it's what one does. Our syringe pump tubing volume is 0.4 mL, so it works for most minuscule-volume meds to use this method. Typically, with very few exceptions (adenosine is one), the recommended infusion time is a minimum, so even if it takes longer than 15 minutes for the patient to receive the whole dose, it's not likely to harm the patient in any way.

[Julius Seizure]

Yup, you can do that (push the med, then run the flush on the pump). Just remember that if the med is 0.4ml and your tubing is 0.8ml....you have to really think about how fast the med will be flushed in. If you set a 1ml flush to run over 15 minutes, then the 0.4ml of actual med will be infused in less than half that time, followed by 0.6ml of the flush.

Its a good thing to think about though. Many nurses run the 0.4ml med, then push the flush and dont realize that all they did was slowly put the med into the tubing, then gave it to the patient all at once.

[NotReady4PrimeTime, RN]

Its a good thing to think about though. Many nurses run the 0.4ml med, then push the flush and dont realize that all they did was slowly put the med into the tubing, then gave it to the patient all at once.

I see that all the time with central lines. The lumen might have a volume of 0.8 mL; the med is slowly infused into the lumen then the flush is slammed home. Not a lot of thought applied.

[NICU Guy, BSN, RN]

If your tubing holds .8 mL, then prime the med (0.4mL), then prime 0.4 of saline, set the pump to administer 0.4 over 15 minutes and let it infuse another 0.4 mL of saline over 15 min.