IV push concerns

[eyeball]

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

[pippylockstocking]

From what your original post said... personally I do not think this was "sloppy" at all. She was teaching you a little trick to spend your time wisely.

1) I assume you have computerized charting which means that your laptop is in the room with you while you are doing the meds. I often connect a IV push syrine, push a small amount of the bolus through, let it stay there a few seconds, while I check things on the computer. I am always double and triple checking the MAR. I will then go back to the IV push after 10 seconds or 20 seconds, push a little more in, and depending on the type of medication, I will continue this method until all the medication is administered. Some meds are quick pushes (1-2 minutes). Other meds are much longer (5 minutes). This is a great way to use your time wisely. You can even chart while you are waiting for the 5 minutes to elapse. Or you can just make conversation with the patient... patients love when their nurse's talk to them!

2) The Normal Saline acted as your flush following the med. I do this on a daily basis. It's much easier to give IV pushes when the patient has continuous IVF's. (granted they are compatible) It save you time of having to draw up a NS flush for the initial flush, and a 2nd flush for the final flush. I usually don't stop the infusion though if they are compatible. As long as the fluid is running at a slow rate... it's helping to deliver that med at a few drops per second. Of course it depends on the med, the rate the pump is set at, etc.

3) As for the blood in the syrine... why do you think this is "sloppy". When you are assessing your IV sites (saline locks, heplocks, etc) do you not check for positive blood return? That is how you know the catheter is still in the vein and not dislodged or infiltrating. To prevent the blood from backflowing into the IV tubing, you probably could have kept one hand on the syringe, to prevent the "push" back of the plunger. While your other hand could have attended to the laptop/charting.

I hope this makes sense to you... I know how it feels to be a new grad and things don't make sense. Ive had similar situations happen to me as a new grad.

[ToughLover]

All you have to do is keep your infusion running, connect your med to the port closest to the patient and push a little at a time. The solution will flush continuously and you won't give them the med all at once. Blood won't back up if you don't stop the infusion. No biggie! But typical of preceptors to tell you "their way" not the "right way". Good of you to ask advice though, if it seems wrong, it probably is.

[NoviceRN10]

3) As for the blood in the syrine... why do you think this is "sloppy". When you are assessing your IV sites (saline locks, heplocks, etc) do you not check for positive blood return? That is how you know the catheter is still in the vein and not dislodged or infiltrating. To prevent the blood from backflowing into the IV tubing, you probably could have kept one hand on the syringe, to prevent the "push" back of the plunger. While your other hand could have attended to the laptop/charting.

I hope this makes sense to you... I know how it feels to be a new grad and things don't make sense. Ive had similar situations happen to me as a new grad.

I was never taught to check for blood return from a saline lock to see if it was still in the proper place.

[ChristineN, BSN, RN]

I was never taught to check for blood return from a saline lock to see if it was still in the proper place.

Because IV's that have lost blood return (which is common for smaller gauges) are not necessarily "out of place." You have to also look at the skin around the line, see if the pt is complaining of pain r/t the IV etc. Alot of times a small gauged PIV is still patent despite no blood return.