IV Push Meds Help

[almostnrs0131]

Being a student I have questioned many RNs about the rate to push certain IV meds such as Lasix. The med book says 1mL/min. so as not to bolus the patient. Some RNs give it in an upper port of the IV pump (NS @ 125) over about 30 seconds for 4 mL. For IV pain medications (Dilaudid, Fentanyl) some will give them in upper IV pump ports and others say to give the patient immediate relief it needs to be given in the lowest port. This is very confusing as to the best practice and patient safety. Any thoughts on best practice for this subject?

[Asystole RN]

The best practice is to turn the pump off or pause the flow, either disconnect the IV line and access the needless port itself or push through the closest port to the patient (best practice is to disconnect the IV line). Flush the IV to ensure patency within the vein, push your med over the given time as described in your drug book, flush again and reconnect or restart the IV.

Why flush an already infusing line? An infusing line with lets say NS with a typical rate of 100-125ml/hr is actually rather slow. What is that 10-12 10ml flushes an hour? A PIV that has infiltrated may have little to no pain if the infusion is slow and the machine will obviously not be aware of any difference. Giving an IV push med with its high concentration of med into an infiltrated PIV can cause a major boo boo.

You see this sometimes with the elderly and especially with the comatose. IV infusing great until you go back in a couple of hours and their entire arm is as big as their leg.

Your facility should actually have an IV medication administration policy, if not then your pharmacy will. If your facility has an IV team or any CRNIs they are a great asset.

[anonymousstudent]

You should be going into the port closest to the patient.

As far as rate, you need to give the med SAFELY. Which means no faster than the rate in the drug book. This is one of the decisions you get to make about how YOU will practice. We all know that things don't always happen the way they should. Why is that? Is it really that there isn't enough time? I don't know, I'm not there, but I'm also not going to work my *** off for my RN and then have it taken because I didn't have 45 more seconds to push a med. If somebody really wants to get on me about being slow because I was giving a medication correctly, BRING IT ON. I'm not the one to mess with, I promise.

Lasix is 4 mg / minute. Period. Just do what you're supposed to, you'll be fine. :)

[almostnrs0131]

Thanks for your reply. I have always felt that way about patient safety and doing things right far outweighs saving time. Thanks for the support.