IV Push Medication

[nursejada001]

I'm just curious, what is the rationale behind administering IV push medication on the last port of an IV tubing??

Where can I get references??

Thanks.

[NicuGal, MSN, RN]

Think about it, why do you want to give something push? If you give it up higher in the tubing is it going to take longer or shorter to get to the patient?

[nursejada001]

I know what you're saying, but there are medications ie. chemo meds given IV push but are required to be administered over 15mins. In these situations, what's the difference/rationale for administering it from a higher port versus the port closest to the patient?

[NicuGal, MSN, RN]

Look at compatibility also, some state distal port only.

[Asystole RN]

If you ever give something IV push with color you would know this answer.

IV tubing tends to hold a significant portion of the medication for an extended period of time unless there is a large amount of fluid flowing relatively quickly through it. You will see medication pool around turbulent junctions in the tubing due to areas of low flow or disrupted flow.

Although not the same exact mechanisms but look at IV blooding where you infused blood in it. You will see pools of blood trapped in various areas of the tubing for long periods of time despite significant flushing.

To get a good visual and/or test this take some IV tubing and push some grape juice and then see how easy/hard it is to completely flush the line without opening the IV to full.

0.5-1ml of trapped medication makes a difference when the total volume is 3ml.

[akulahawkRN, ADN, RN, EMT-P]

For IV push medication, I would actually usually prefer to push the med right at the catheter hub. Extension sets with a T connector at the hub allows the shortest fluid distance between the port you're pushing the med into and the blood without disconnecting the IV line from the catheter hub. If the IV line has only one or two ports and it takes, say, 2 mL to flush from that port and I have a med that's only 1.2 mL by volume, it's going to take a while for that med to get to the patient, especially if the IV is only running at 20 mL/hr. If the fluid volume is but 0.1 mL between the port and the cath tip, well... quite a bit of a difference I'd say!

[cancer.sucks]

but there are medications ie. chemo meds given IV push but are required to be administered over 15mins.

When a chemotherapy medication is given IV push blood return also has to be frequently assessed. The nurse has to be in complete control of the infusion port, the syringe, the line, and the injection site at all times especially when pushing a hazardous chemical like chemotherapy. It is not practical to pull back for blood return at a higher port, too much drug has to be aspirated to get that blood return. Additionally, too much chemotherapy is potentially in the tubing to safely aspirate back in the case of extravasation. By pushing any drug into the port closest to the patient it reaches the patient faster for efficacy (opioids and steroids) and is safer because the nurse can assess the injection site much more consistently during medications classified as irritants or vesicants (phenergan, chemo, etc).

[FinallyRNStatus, BSN]

Asystole - what a excellent response! Being a visual learner this analogy has helped me greatly!

Perhaps you are a visual learner too?