IV push concerns

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I am a new grad/orientee on a very busy telemetry-medsurg floor. Yesterday, I was pushing IV Nexium through an already infusing line (0.45NS), something I have never done but have read about. I was instructed by my preceptor to put the IV pump on hold and then push the med through the port. She then instructed me to drop the syringe with the nexium and let it hang so I could "work on my assessment" in the computer and intermittently push the med in in the name of "developing good time management skills."(Note: my patient had pain issues and spent most of his time standing which was more comfortable for him) I questioned it cause it struck me as very odd and she insisted it was ok and left the room. I worked on the assessment for 20 seconds and turned around to push a little more in and noticed both the IV line and port line filling with blood. I gasped and my patient gasped. I said, "Just one moment" and stuck my head out the door to call her. She came in and stated that this was no big concern and that all the blood would make it back into the patient anyway. She took over and proceeded to push the rest of the nexium in and turned the NS infusion back on. The bloody lines did eventually clear but both my patient and I were freaked out. I've been with this preceptor for two weeks and being a new grad I'm not able to draw the line between what constitutes acceptable corner cutting vs. what is sloppy and/or dangerous practice. I'm getting a strong message in my training that nursing school nursing and real nursing are two different ball games and that all real nurses cut corners in order to be able to get through the day. I've witnessed sevral instances of sloppy practice on my preceptor's part.

My question is, was this method of pushing nexium acceptable and safe in real world nursing and am I just too inexperienced to know the difference? My gut tells me it was unsafe and unacceptable practice not to mention frightening for the patient. Please clue me in....Thanks

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I'm a new grad also (May) but I have done similar pushes. The only difference is that I do not turn off the solution that is already infusing...because it helps to flush the medication in.

For example... pushing Zofran, phenobarbital, or a large dose of Solu-Medrol. I might push a 1/2mL then listen to bowel sounds... then push 1/2mL and listen to heart sounds... then push 1/2mL and check pedal pulses and check for edema... and so on. It really does help with time management rather than taking 3 minutes to push a med or being impatient and pushing it faster than it should be done. But again... the difference is that I keep the already infusing IV solution on because it helps to flush the medication through.

If you are truly concerned maybe you can talk to you Clinician.

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I've done the same as well, but like the previous poster said I don't turn off the infusion (granted it's compatible). If I'm giving something that needs a longer push (like Compazine or Pepcid), I put it in a 50cc bag of NS and run it so I don't have to stand there for 4 or 5 minutes.

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How much blood was in the iv line and port line? I have had pts who were saline-locked have blood back up into their iv line. Its not something that concerned me. I have also seen blood back up into a line when I stopped an infusion for a few minutes.

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Specializes in Oncology, Hospice, Med-Surg.

I'm a new grad also but I think that makes no sense to do a slow IV push when you stop the infusion because the med would sit between there and their vein and than when you turn the fluids back on it would be almost like a fast push because the fluids and med would go in in a few seconds. Let me tell you that anytime that little part of my brain that said uh oh something is wrong it's something we should trust. I saw one nurse with experience push a med through tubing that a piggyback had just ran through (she didn't look at compatibility) and I thought there is no way all of that would be out yet. Sure enough precipitate formed and she pulled that tubing off that patient. I also once saw a nurse hook up TPN to a peripheral site and I started to question her when the pt complained of burning. I think sometimes that when these seasoned nurses train they get distracted. Not to I know everything, I know that as a new grad I'm learning but I try to trust my instincts.

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Specializes in LTC & Private Duty Pediatrics.

Why the hell would you ever, every walk away from a med (or focus your attention on something else ... while doing an IV push?).

How many of us would get distracted and and "forget" about the IV push? Heck, how many of us here have forgotten to turn on the IV pump again?

Seems like an easy screwup. Imagine JCAHO walking in on a patient and seeing a half-filled syring of "stuff" hanging off an IV port.

Just my two cents.

SirJohnny

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How much blood was in the iv line and port line? I have had pts who were saline-locked have blood back up into their iv line. Its not something that concerned me. I have also seen blood back up into a line when I stopped an infusion for a few minutes.

About a foot of bloody infusion in the IV line and the push syringe itself got bloody looking including the port line.

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Why the hell would you ever, every walk away from a med (or focus your attention on something else ... while doing an IV push?).

How many of us would get distracted and and "forget" about the IV push? Heck, how many of us here have forgotten to turn on the IV pump again?

Seems like an easy screwup. Imagine JCAHO walking in on a patient and seeing a half-filled syring of "stuff" hanging off an IV port.

Just my two cents.

SirJohnny

This is my thinking as well.

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Specializes in Cardiac.

I would not leave an IV push med unattended, but I have seen it done. To note SirJohhny, I walked into a room one night to find an unlabeled syringe attached to a port, half full. I have no idea what it was and day nurse was already gone so I couldn't ask her. I had to discard it, not knowing what it was or how long it had been sitting there. Blood back-up is not too big a deal it happens even while meds are infusing.

I wouldn't make this a habit. It is definatly "cutting corners" and a preceptor shouldn't be teaching a new nurse to cut corners as well.

On second thought, I do not pass meds until I fully asses pts anyway. How do you know if something in his assessment contraindicates that med if you haven't assessed him yet?

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Specializes in Infusion Nursing, Home Health Infusion.

Well Obviously a good IV site. If the Nexium was compatible with your primary infusion there was no need to put the pump on hold or shut it off...however..if incompatible best to give it at the t-extension or Y site of your device (depends on the product you use) ...use SAS...give your saline...give your push med..give your saline. What happened was that the pressure in the vein forced the blood into your tubing. You should try to avoid this b/c not only can you clot off your line...all that blood coated on IV tubing and stuck at Y sites..sits there and puts your pt at increased risk for infection. If you did have to shut the pump off or place it on hold and give it at a Y site..then push your med at recommended rate ( DO NOT EVER LEAVE unattended) ..if the med is still siting in a significant amt of tubing..then you should also give your saline after that at the same rate...GET IT? b/c its just sitting in the tubing. I have seen many a nurse make this slight technical error..once with Dilantin..it was sitting in the tubing and then she slammed her final saline flush in and the pt had severe Bradycardia. As far as safety goes the practice she showed you is sloppy nursing care..SAFETY is a BIG thing these days and keep in mind that IV related issue lawsuits are the highest number of lawsuits that nurses face so be wise...and never take this shortcut.

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Specializes in Pediatric/Adolescent, Med-Surg.
I'm a new grad also but I think that makes no sense to do a slow IV push when you stop the infusion because the med would sit between there and their vein and than when you turn the fluids back on it would be almost like a fast push because the fluids and med would go in in a few seconds. Let me tell you that anytime that little part of my brain that said uh oh something is wrong it's something we should trust. I saw one nurse with experience push a med through tubing that a piggyback had just ran through (she didn't look at compatibility) and I thought there is no way all of that would be out yet. Sure enough precipitate formed and she pulled that tubing off that patient. I also once saw a nurse hook up TPN to a peripheral site and I started to question her when the pt complained of burning. I think sometimes that when these seasoned nurses train they get distracted. Not to I know everything, I know that as a new grad I'm learning but I try to trust my instincts.

Technically some facilities will let you infuse TPN via a peripheral as long as the Dextrose is 12.5% or less. However, it still burns.

I personally always turn on my main IV fluid, flush with a couple cc's of NS, slowing push the med, and then slowly flush with NS before turning my main fluid back on.

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I feel strongly that IV push med administration is one of those safety issues where you should have NO distractions. You should focus on that task only and assess your pts for S&S adverse reactions during the IV push. It's also a great time to converse with your patient, assess with your eyes, educate...etc all while keeping yourself focused on the task at hand and assessing the pt's response. Just my humble opinion. :twocents:

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