Hanging vs Pushing IV Meds- Which do you do?

[mitral]

Hello, we were having a bit of a debate with the nurses this week and I wanted to see some other opinions. For a patient with a central line, one of the ports was p-locked. The patient was to get IV push steroid. So she gave it through the port with a 10ml 0.9 flush before and after, and diluted the steroid with 0.9 as well. After this, a more experienced RN reprimanded her because she said you can't ever give anything through a port without using a filter. Now this nurse did have IV antibiotics hanging which were running through a filter but was not using one for her push meds. So the big debate is, should she have used a filter for IV push? I am pretty confident in my belief on this but I would appreciate your thoughts :)

[SoldierNurse22, BSN, RN]

A filter? Not unless it's needed for the drug itself. Otherwise, I'm not sure why you'd need a filter to push meds on a central line.

Weird.

[inchii]

Definitely depends on the medicine. I won't use filter for steroids. And what antibiotic was it that you needed a filter? Maybe it's a hospital policy?

[Esme12, ASN, BSN, RN]

I don't use a filter for IVP even on central lines.....unless the drug or container required it.

Is this a facility policy?

[Christy1019, ASN, RN]

What is p-locked? And no, I've never used a filter for central line or any IV unless the med required it.

[RNlove17]

What is p-locked? No I have not used a filter for IVP on central lines... unless the drug required it.

[iluvivt, BSN, RN]

You do not need to push the steroid through a filter first. I would venture to say that most hospitals do not routinely filter routine IV therapies because it does increase the expense of IV therapy. Some do so check your policy just to make sure! This would be an add on or inline .22 or 1.2 micron filter. In some case you do need to filter certain medications and IV therapies such as Remicade, Mannitol ,Amiodarone, Dilantin and TPN. Perhaps because TPN must be filtered and is given through a central line she thinks that all medication given via a central line must be filtered but that is not the case. It is not mandatory nor does current evidence support their routine use.Filters are used to retain particulate matter,such as glass and rubber stopper pieces, trap bacteria, trap endotoxins air and other contaminates and the may help in reducing peripheral phlebitis.

[mitral]

Thank you, your answers are very helpful! I too felt it was excessive filter use and could not find any policy specifically stating that it was necessary. Probably as one poster suggested, she just misinterpreted the mandatory TPN filter use. Our facility filters anything that will be running long term, even just 0.9, that may have something to do with it too. P-lock is a term for heparin locked/line not in use, just capped.

[SierraBravo]

That is interesting that all long term IV's need to be filtered in your facility. I wonder what the rationale is for that? Aside from the usual suspects needing to be filtered like TPN, etc... I never filter anything. Amiodarone comes from pharmacy with tubing that has an inline filter. When you filter something, inherently less drug gets to the patient because some is caught up in the filter. I would challenge that policy and try to understand what the rationale is. In terms of pushing vs. hanging, 99% of the time I throw my med in a 25mL NS bag and hang it. I always have med lines running on my patients and they all have central lines. By hanging it and running it over however many minutes I need to it frees me up to do other things like assessment, etc... instead of having to stand there for 1-5 minutes. But this is just personal preference. Of course, in an emergency I will push things. But I also dilute my IV push meds into a 10mL syringe with NS, too.