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 Hospice, corrections, psychiatry, rehab, LTC.
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. :)

This seems like the safest course. Sure, you might save a syringe and a vial of NS by looking everything up, but flush, push, flush and restart.

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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.

This is incorrect. I worked in a unit where we routinely did this with IV flush syringes and as long as you labeled it and said EXACTLY what is in it, date it, time it, sign it, it is absolutely acceptable.

You don't even need to do that if you are giving it immediately and discarding it. However, if you set it down or don't use it immediately, you have to label it.

That is no different than NS bags that the pharmacy adds medication to and then puts a sticker on them to tell you what drug is in it.

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Specializes in Critical Care.
This is incorrect. I worked in a unit where we routinely did this with IV flush syringes and as long as you labeled it and said EXACTLY what is in it, date it, time it, sign it, it is absolutely acceptable.

You don't even need to do that if you are giving it immediately and discarding it. However, if you set it down or don't use it immediately, you have to label it.

That is no different than NS bags that the pharmacy adds medication to and then puts a sticker on them to tell you what drug is in it.

I'm not saying it's never done, but it's incorrect that this is widely accepted as a safe practice. Unlike the type of plastic used for IV fluid bags, labels/tape often don't stick well to syringes, so when a label falls off of a syringe that is factory labelled as NS you've now got a syringe that appears to an NS flush, not an syringe which is just unlabeled with unknown contents which would be treated as such.

I often do it myself as well when I am giving something immediately, but to be told by a preceptor that you should just know this is the standard way of doing it is incorrect, it's not that broadly accepted.

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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.

Wow...seriously...wow.

All nursing schools teach you look up medication or find out how to look up the policy.

All of them. It is on your NCLEX.

If you have a new RN that doesn't know that they need to look up an unfamiliar medication or ask where to find the policy on administration, then you have an RN that probably is deficient in other areas and really shouldn't be working at all.

You didn't understand the point of my comment. The point was they purposely gave me an unfamiliar medication. They wanted to see if you don't know what to do...how would you proceed? I knew enough to ask how to find the information. I knew enough that if you did not know if the medication was compatible, you went with the safest route of administration, but you still need to find out how it is supposed to be given.

I couldn't disagree with you more. I think that is the difference between when you went to nursing schools versus some of us that have went in the last 10 years. They teach you it is YOUR responsibility to find the information and YOUR responsibility to find out where to look it up. The policy may be different on a few medications per facility, but 95% of it is fairly standard.

I have looked up many medications because I took responsibility for my own practice. Compatibility of drugs DOES NOT change by facility and you sure as heck don't rely on someone to TELL you the information.

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Specializes in Critical Care.
Wow...seriously...wow.

All nursing schools teach you look up medication or find out how to look up the policy.

All of them. It is on your NCLEX.

If you have a new RN that doesn't know that they need to look up an unfamiliar medication or ask where to find the policy on administration, then you have an RN that probably is deficient in other areas and really shouldn't be working at all.

You didn't understand the point of my comment. The point was they purposely gave me an unfamiliar medication. They wanted to see if you don't know what to do...how would you proceed? I knew enough to ask how to find the information. I knew enough that if you did not know if the medication was compatible, you went with the safest route of administration, but you still need to find out how it is supposed to be given.

I couldn't disagree with you more. I think that is the difference between when you went to nursing schools versus some of us that have went in the last 10 years. They teach you it is YOUR responsibility to find the information and YOUR responsibility to find out where to look it up. The policy may be different on a few medications per facility, but 95% of it is fairly standard.

I have looked up many medications because I took responsibility for my own practice. Compatibility of drugs DOES NOT change by facility and you sure as heck don't rely on someone to TELL you the information.

I obviously missed where the preceptor criticized the OP for not looking up the drug, the only thing I saw mentioned was that the preceptor criticized the OP for not knowing to pause the heparin with the apparent argument that every nurse does this, which they don't, nor do they need to.

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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.

Seems like a waste of resources. Glad our hospital doesn't have this policy.

If I'm administering it immediately and I know exactly what I put in it and that it was done aseptically...then I really don't see a problem with it.

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Specializes in Acute Care Pediatrics.
Seems like a waste of resources. Glad our hospital doesn't have this policy.

If I'm administering it immediately and I know exactly what I put in it and that it was done aseptically...then I really don't see a problem with it.

Our hospital has this policy. It's ridiculous. And I don't know anyone that follows it.

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Specializes in SICU.

If I'm giving s heparin gtt i will ALWAYS have another IV in place.

Patients have abx and maintenance fluid and usually need more than one IV access. In my opinion it is the failure of your preceptor to critically think about the need for additional

Access so that you are not continually stopping heparin therapy to give prn drugs...

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Our hospital has this policy. It's ridiculous. And I don't know anyone that follows it.

You know, this seems to me like the manufacturer got wind of what was going on and made the hospitals augment their policies so as to avoid any liability.

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Wow...seriously...wow.

All nursing schools teach you look up medication or find out how to look up the policy.

All of them. It is on your NCLEX.

If you have a new RN that doesn't know that they need to look up an unfamiliar medication or ask where to find the policy on administration, then you have an RN that probably is deficient in other areas and really shouldn't be working at all.

You didn't understand the point of my comment. The point was they purposely gave me an unfamiliar medication. They wanted to see if you don't know what to do...how would you proceed? I knew enough to ask how to find the information. I knew enough that if you did not know if the medication was compatible, you went with the safest route of administration, but you still need to find out how it is supposed to be given.

I couldn't disagree with you more. I think that is the difference between when you went to nursing schools versus some of us that have went in the last 10 years. They teach you it is YOUR responsibility to find the information and YOUR responsibility to find out where to look it up. The policy may be different on a few medications per facility, but 95% of it is fairly standard.

I have looked up many medications because I took responsibility for my own practice. Compatibility of drugs DOES NOT change by facility and you sure as heck don't rely on someone to TELL you the information.

Glad I wowed you.In orientation the orientees are there for guidance.They require someone to tell them the information. And.. that's okay!

Never took the NCLEX. However, I did enjoy precepting the many nurses that required my teaching skills. I did not challenge them.. or refer them to a manual. I taught them how to apply what they learned in school into the real world. They all succeeded. Nothing beats learning by example.

Signed,

Crusty Old Bat

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Specializes in Critical Care.
If I'm giving s heparin gtt i will ALWAYS have another IV in place.

Patients have abx and maintenance fluid and usually need more than one IV access. In my opinion it is the failure of your preceptor to critically think about the need for additional

Access so that you are not continually stopping heparin therapy to give prn drugs...

I don't think there is any obvious reason to use a separate IV access, what are you basing that on?

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Specializes in Critical Care; Recovery.
I don't think there is any obvious reason to use a separate IV access, what are you basing that on?

I'm thinking all the reasons that they listed. You don't think it's convenient to have more than one IV access when you have abx that have to go in intermittently? Typically if you have a heparin infusion going, say for a NSTEMI, you would want to have another iv already in place anyway in case the first infiltrates so that you can simply switch the heparin gtt over instead of having turn the infusion off while looking for a new iv site. I'm thinking you must have misunderstood their post.

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