IV push failure - how I am failing

LadyFree28, BSN, LPN, RN · Jun 8, 2015

The best advice I can give you is to make sure before you do anything related to IV push is to know your P&P, as well as compatibility of meds.

If someone is on a high-alert med, it's best to stop the med and flush with normal saline prior to administering the med; but always refer to your policy and procedure of handling high alert meds and IV administration.

Best wishes.

psu_213, BSN, RN · Jun 8, 2015

Any time you 2 meds share IV tubing--either Y-siting two drips or if you push a med into a line running a med--you have to make sure they two meds are compatible. If they are not, the meds could react and form a precipitate (a solid that would form in the line as a result of said reaction). You can check IV compatibilities in a drug book, on the computer using a program such as Micromedex, or by calling the pharmacy.

To answer the last question--there is way too much to "know" about IV therapy to go over it all in one AN post.

16mm · Jun 8, 2015

Interesting! I don't have any advice seeing how I'm just a student, but I do appreciate you sharing your new found knowledge. I wonder what the rationale is for this? But honestly, I feel that if your job wanted to fire you, you'd be fired, not getting an extra week of orientation. Seems like they want you to succeed!!

ETA: I see the rationale now as the two posters above me so graciously shared. Thanks!

~PedsRN~, BSN, RN · Jun 8, 2015

When all else fails, if you are running something besides just plain old IVF - stop the infusion and flush the line. I don't even both checking compatibility. It's two to five minutes. Stop the infusion, flush the line. :)

Nonyvole, BSN, RN · Jun 8, 2015

Know your resources to look up what medications are compatible to be given through the same IV at the same time. (heparin and morphine are)

Another reason - the bigger one, in my mind for this situation - is that by pushing the morphine while the heparin is going, you are also giving them a bolus of heparin. So suddenly their heparin dosage is off and that can affect all sorts of things, yes?

What I like to do is stop the pump, disconnect the line altogether, flush the IV, give the IVP med, and then reconnect (and restart!) the drip. Or us a different IV access, but I'm also the sort that if the patient is getting a controlled drip like that, then I want at least two peripheral IVs in. Central line is preferable, but that's just me. Most of the meds that I'm giving via pump are things like heparin, insulin, pressors, and sedation, so I really don't want to mess around with them more than I have to. Patient needs them for a reason...

NursesRmofun, ASN, RN · Jun 8, 2015

This is the type of thing you learn at work. You don't really learn it in school. Ask questions...and use your resources includ. pharmacy. Look up your meds. Even after orientation is over, you will need to ask questions and use resources for a long while. Actually, I still ask questions when in doubt or in new situations....or giving meds. I've never given before.

ScrappytheCoco · Jun 8, 2015

How long have you been on orientation? I feel like she should have explained this to you and not expected you to "just know." I feel like a lot of preceptors do that and it really is a disservice.

Susie2310 · Jun 9, 2015

What were you taught about IV drug administration in nursing school?

Jory, MSN, APRN, CNM · Jun 9, 2015

I am new to the hospital environment and brand new to IV meds so when my preceptor said it was a mistake not to pause the heparin drip before doing an IV push dose of morphine I expressed understanding and told her I never knew that. I honestly don't remember learning that in nursing school so she told my boss and now they've added another week of orientation for safety concerns.
I am terrified they're going to fire me. I already had an extra week of training to hone my time management skills and then I do this! I just worry that there are other deficits in my education that will lead me to endanger a patient or get fired and I'm 37 weeks pregnant so I'm about to go on leave without really being on my own. I just feel like I'm failing and the preceptor says I didn't seem to understand how serious this mistake was. She's right. I didn't. I don't know what I don't know, you know? Are there other things specific to IVs that I should be aware of before I kill someone?

I'm not trying to be mean but seriously...this is basic nursing. If you are doing a lot of guessing and winging it, then yes...you are unsafe.

None of us graduated with a drug encyclopedia and compatibility guide in our heads....but every one was taught you never give IV meds without determining compatibility.

The problem is not in you not knowing....it's the fact you didn't know enough to look it up. That's how patients end up harmed.

OCNRN63, RN · Jun 9, 2015

Know your resources to look up what medications are compatible to be given through the same IV at the same time. (heparin and morphine are)
Another reason - the bigger one, in my mind for this situation - is that by pushing the morphine while the heparin is going, you are also giving them a bolus of heparin. So suddenly their heparin dosage is off and that can affect all sorts of things, yes?
What I like to do is stop the pump, disconnect the line altogether, flush the IV, give the IVP med, and then reconnect (and restart!) the drip. Or us a different IV access, but I'm also the sort that if the patient is getting a controlled drip like that, then I want at least two peripheral IVs in. Central line is preferable, but that's just me. Most of the meds that I'm giving via pump are things like heparin, insulin, pressors, and sedation, so I really don't want to mess around with them more than I have to. Patient needs them for a reason...

That's what I would do when I would give certain drugs in oncology that required, for example, a diuretic in between agents. (Don't ask me for an example; it's been a couple years since I gave chemo.)

You need to look up compatibilities when you are giving multiple agents/fluids. After you've been doing it a while you'll get to know many of the more common ones, but until then, have a reference at the ready.

Been there,done that, ASN, RN · Jun 9, 2015

I am new to the hospital environment and brand new to IV meds so when my preceptor said it was a mistake not to pause the heparin drip before doing an IV push dose of morphine I expressed understanding and told her I never knew that. I honestly don't remember learning that in nursing school so she told my boss and now they've added another week of orientation for safety concerns.
I am terrified they're going to fire me. I already had an extra week of training to hone my time management skills and then I do this! I just worry that there are other deficits in my education that will lead me to endanger a patient or get fired and I'm 37 weeks pregnant so I'm about to go on leave without really being on my own. I just feel like I'm failing and the preceptor says I didn't seem to understand how serious this mistake was. She's right. I didn't. I don't know what I don't know, you know? Are there other things specific to IVs that I should be aware of before I kill someone?

If you are still in orientation.. any medication you administer is under the direction of your preceptor.

Your preceptor failed to teach you the protocol.

You are in orientation to learn. You are not failing, the preceptor is.