IV push failure - how I am failing

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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?

Specializes in Med-Surg.

You made a mistake, now you won't make it again. Hopefully you have easy access to a drug guide resources so you can look up your medications. You may not have started the heparin infusion but you still need to look up any continuous infusions started before your shift.

I love my facilities online resources! The more you work on your unit and get familiar with the frequently administered drugs, the less you will need to look information up. Can you ask your preceptor for a list of common fluids and medications given on your unit? Make notes when you find something isn't compatible (like cefitraxone and lactated ringers).

For what it's worth, we weren't allowed to push or hang any IV medication (even saline) in either my LVN or LVN-ADN bridge programs. School policy. While yes, you should look up any drug before giving it, I can see how a mistake like yours can happen when you aren't very familiar with the medications (and implications of administering a "bonus" volume).

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Specializes in Critical Care; Recovery.

You need to ask questions when there is a possibility that you don't know what you're doing. This is why you have a preceptor in the first place. I've been an RN for three years and I am very quick to ask for advice or admit I don't know something. Sometimes I ask experienced coworkers questions when I think I know the answer already just to see what they say and if they have any additional information to offer. Never be ashamed to admit you don't know something, even if you think you should already have learned it.

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Thanks backtothebeach

im gonna review it now

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I agree. They looked at me like I was crazy for not knowing to dilute mrophine IV push but that's how dayshift trained me to do it. I wish they wouldn't give that reaction when I ask a question. I ask and they're like "you didn't know that?! That worries me!"

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I don't usually dilute morphine 😕

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I don't if they have running IV fluids (esp NS). I just push it into the furthest away port. If they don't, then I'll dilute it into the 10 ml flush and give it slow. I've had little old ladies who were very sensitive to morphine go ham on me before. That's why I always make sure to do it really slow nowadays.

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We just had a big in service training as past practice was to use 10 ml NS flushes as a dilution as mentioned above and then into a port. Now is verboten, flushes can only be used for flushes, thats why it says flush only on the syringe. So now, get MT syringe and draw up NS and med.

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Flush only used for flush?! See. I can't find policy on how to dilute morphine but it says I must dilute it. I've been using NS flush. What are you drawing it up from? Is there a normal saline vial I should be looking for?

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Specializes in Critical Care.

I have to disagree with apparently about everyone here and say your preceptor was incorrect to say it's generally understood and practiced that the heparin should be paused when using a y-port. Pausing the heparin pump really makes no difference; heparin and morphine are y-site compatible, and the issues you need to consider with the volume of the lumen beyond where you are y-site infusing has nothing to do with pausing the pump.

It's also not widely agreed that diluting a morphine push by drawing it up into a partially emptied saline flush is a good idea, and actually ISMP specifically recommends against that as a safety concern.

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Specializes in Critical Care.
Flush only used for flush?! See. I can't find policy on how to dilute morphine but it says I must dilute it. I've been using NS flush. What are you drawing it up from? Is there a normal saline vial I should be looking for?

Is It Really Saline

The concern is that by using a syringe that is labelled as "Normal saline" and adding a medication you now have a mis-labeled syringe which could lead to an error. What's recommended (if there truly is a need to dilute) is to use vial of NS to draw the medication and the NS into an unmarked or properly labelled syringe.

I would be curious for there source that says morphine must always be diluted, it's generally available in concentrations that are specifically intended for IV push use, so there isn't really any reason to dilute it.

I think what might really be going on is that your preceptor has some misinformed beliefs and falsely believes you are misinformed because you don't already hold those same beliefs, when really the only problem is that you haven't yet learned your preceptors bad practices, which is actually a good thing.

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Any drug in syringe not for immediate administration by the person drawing it up MUST be labelled, everyone should be using the stickies for that- which is what we were doing and using it for IVP and also to add via the pump through the B side or ESP- there a zillion around, pre-filled, right thread.... but NS Flushes clearly state "To be used as flush only" using it as for medication administration or any other purpose except flush was a clear violation of its intended purpose and manufactures license and bad practice- which is why we had the training.

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I disagree. If she passed her boards, she was taught to look drugs up before giving them. IV infusions OR pushes. You don't rely on the preceptor for this. If there is a protocol, it's written somewhere, I guarantee she was told in orientation where to find them.

When in doubt, call the pharmacy.

I disagree that the preceptor is failing.

PS: I never pushed any drugs unless you count saline when I was in nursing school. I gave pills, started IV's, hung and changed out saline, that was it. However, IV compatibility is ANYTHING in the IV line. Doesn't matter if it's an infusion or a push. You have to check.

I was given a scenario of a drug I had never heard of during a demonstration during orientation at my first job. I asked for a drug guide. The nurse running the demo handed me one. The bag that was infusing contained potassium, the drug was not compatible with potassium. I looked at her and told her this and she smiled and said, "Correct...now what would you do?" I said, "Find out if this drug can be given IM or if it needs to be given by IV, stop the infusion, clear the line with saline or start a second PIV." She said, "Correct".

Unless it was a critical infusion (which I would learn about later), if you knew nothing else about incompatibility, you ALWAYS clear the line when in doubt....and like the other poster said...you have to know what is running to see if it is safe to "bolus" what is left in the line.

Disagree. Orientation is the time to be SHOWN medication administration per facility P&P.

This is not the time to hunt the manuals and try to follow them.

I've had many orientations, precepted many nurses. Never failed on either end.

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