IV PUSH- if anyone can help please

[futurenurse09]

Hello. I am currently learning IV Pushes and would some clarification on this part. If someone could help answer this for me. Please bare with me, and I apologized if my wording is confusing. Here goes:

EX: I am going to be administering (2ml, over a rate of 2 min) on a hep lock. Lets say the extension tubing holds 1ml. 

From what the instructor demonstrated: since there is NS currently in the extension tubing, I could push 1ml of the medication into the tubing, then "start" timing when I start pushing the second ml (at it's rate of administration), in this case about 0.25ml per 15 seconds. Is that correct? IF so, what if the medication amount is less than what the extension tubing is? Say 0.4ml to be given over 2 min? Could I push the entire medication amount into the tubing, then I would flush it at the same rate I would administer the med- about 0.1ml every 30 sec?

And would this also apply for a current running line. Say I already checked compatibility with current fluid hanging, etc. Since a Y tubing typically holds 2ml, if I was to administer a medication amount that is less than the 2 ml (ex: 1ml), can I do the same as above? As in Push the entire 1ml into the Y tubing, Then attach a flush and then go the same rate I would with the medication that is administered?

I hope someone is able to assist me in this. Thank you

[Okami_CCRN, BSN, RN]

When pushing small amounts of IV medication (think famotidine 20mg/2ml) it is important to use an appropriate sized syringe (I.e 3ml) because it'll allow you to actually administer at the appropriate rate. 

To answer your question, I typically will start pushing at the appropriate rate regardless of length of extension tubing or Y-site because when I detach the syringe and attach a flush, I push the flush at the same rate as the medication to avoid an incidental bolus. I hope that makes sense. 

[futurenurse09]

Yes, that makes complete sense, and I appreciate you taking your time to answer my question. 

[mmc51264, BSN, MSN, RN]

You're overthinking it. I am not sure if you are really "hep" locking. Best practices have moved away from using heparin. If I am giving an IV push med, I flush my IV with NS to make sure the IV is patent. then I give my medication over desired time (I will admit that after any years, I don't really time it, you kind of get a feel). After I have administered the medication, I do make sure that when I am flushing after giving the med, I flush the saline at about the rate that I gave the medication at. If I have a 10 mL syringe, I will flush with 5 mL before and 5 mL after. 

I pt has maintenance fluids running, that are compatible with the medication I am giving, I just push through the running line at whatever rate I want as the fluids will dilute.