How to IV push

SarahRNBSN · Jan 10, 2008

Where I work, we have a protocol sheet of all IV push meds. This lists the med, normal dose ranges, safe time for pushing the med, and if any of these meds require cardiac monitoring or any other considerations. On my unit, we can't push certain IV meds because we don't do cardiac monitoring (for example: IV Dilantin or IV lopressor). I was always taught to dilute all meds in 10cc NS flush syringe and push (maybe squirt out 1 or 2 cc of NS to draw up the med). As for when exactly to push over the two minutes, there's no exact science. Just flush 1 or 2 cc every so often in even intervals. I figured if the med needs to be pushed over 2 minutes, at the 1 minute mark, I should have about 5 cc left in the syringe. And with some patients and some meds, I may go beyond the minimum time and push the med slower (such as morphine or dilaudid). Not very specific but I hope this helps.

MAISY, RN-ER, BSN, RN · Jan 10, 2008

First check your facility guidelines.

If you are saline locked...I flush...then will push medication...followed by flush and lock. Time slow and steady over whatever the recommended time period is.

If running iv that is compatible....clean port closest to patient....and again, push med for recommended time period.

As far as, narcotics...depends on where you work and who your patient is. Opiate naive, I always will dilute and do slow push(even with fluids running)....sickler...no dilution and pushed over one minute(with fluids running). Also need vitals prior and q 15 with pain reeval.

Other meds require monitoring, cardizem, labetelol, other cardiac etc. also require different amounts of time for push. Always check...if something like an AFib....you may need to monitor then note when and if a rhythm change occurred.

Meds like Lasix must be pushed slowly or deafness can occur...I am sure there are a million more suggestions.

My suggestion, follow your med book and monitor your patients for their reactions. Hope this helps.

Maisy;)

Leo2 · Jan 10, 2008

2ml divided by 4 gives you the amt. to push per quarter, divide total min. in seconds by 4 this gives you the interval for each quarter. leo2

wooh, BSN, RN · Jan 10, 2008

If it's a saline lock, make sure the first cc or so of flush you push as slow as the rest, after all, the first cc you pushed the med, you were really pushing in the flush in the lock, and the first cc of flush, you're really pushing in the med that's in the lock.

jlcole45 · Jan 10, 2008

Kind of a technical question, but I was wondering a few things about IV pushes. First, if you find that a specific drug is to be pushed over 2 minutes, what does that mean exactly? If I have 2cc, do I push 0.5 cc at zero seconds, then another 0.5 cc at 30 seconds, another at 1 minutes and other at 1min 30 seconds?
Second question: where is the research on all of this? I have tried a search and didn't come up with anything.

Many meds you can dilute with NSS to a larger volume (say to 10cc total), which make pushing it over a couple of minutes easier to calculate.

mom4josh · Jan 10, 2008

:yeahthat:

Agree with everything said already. Would add that if it's something like Lasix (40 mg or more), I would use a mini-infuser or put it on as a piggyback to go in over 10 minutes or more. Can drop your BP if given too fast (didn't know about the deafness).

Valium can't be diluted with anything, though. Not even NS.

And, welcome to :an!: (Noticed it was your first post!)

wooh, BSN, RN · Jan 10, 2008

Valium can't be diluted with anything, though. Not even NS.

Don't have a drug guide in front of me, but can't it be mixed with some sort of dextrose? Seems like we'd always get a bag of it just to be on the safe side for flushing. But it's been a while, and like I said, no drug guide in front of me.

GrumpyRN63, ADN, RN · Jan 10, 2008

Generally, I dilute almost everything with NS into a 10cc syringe and push 1cc slowly q15 seconds until in,( will run over 2.5 minutes, but that's just extra prudent in mybook) there are exceptions of course that have to be pushed slower , and then I just increase the time to q30 seconds will give you 2cc per minute so you push it over 5 minutes

raindrop · Jan 10, 2008

:yeahthat:
Agree with everything said already. Would add that if it's something like Lasix (40 mg or more), I would use a mini-infuser or put it on as a piggyback to go in over 10 minutes or more. Can drop your BP if given too fast (didn't know about the deafness).
Valium can't be diluted with anything, though. Not even NS.
And, welcome to :an!: (Noticed it was your first post!)

How would you piggyback a drug that you have to draw? I have never heard of being able to piggyback something that wasn't already in a bag, and surely, you wouldn't mix something like 40mg Lasix with a 250 bag of NS.....? Just curious.

GrumpyRN63, ADN, RN · Jan 10, 2008

You an just add it to a 50cc bag of NS or D5W and run it on the secondary line at say 200cc/hr--illthen run over 15 minutes, but now wer'eno longer talking about IV push..... but if you don't want to stand there for 5 minutes or so ( like Idon't), just put it in 10cc and runthe secondary rate high --btwn 100-150 cc/hr and it will run over 5-10 min, that's the way we usually run IVP meds

MAISY, RN-ER, BSN, RN · Jan 10, 2008

I will also add push meds to small amounts as a piggyback ....for chf or any other fluid heavy condition...I will not add to additional fluid.

Some hospitals use a syringe pump in pediatrics....this could be helpful when pushing a couple of grams of Rocephin....usually I have the time.

Maisy;)