IV Push Meds Question

fgoff · Sep 1, 2006

I agree go by the drug books recommendatoins... but a Very General Rule of Thumb is slow... over 3- 5 minutes. But the nurse must know the drug som ehave to pushed very fast...

EricJRN, MSN, RN · Sep 1, 2006

Unfortunately it can vary quite widely with the med. Fgoff is right though when he says that slower is generally better. There's only one med I can think of (Adenosine - half-life of only a few seconds) where you want to slam it in.

catlady, BSN, RN · Sep 1, 2006

You should consult the drug book every time you have to give an IV push med that you don't know. For instance, it will take twenty minutes to push a gram of Dilantin (50 mg/min). Lasix is 10 mg per minute, so if you're giving 100 mg, you need to take ten minutes if you don't want to induce ototoxicity. Digoxin is at least one minute. And as Eric pointed out, Adenosine is as fast as you can give it with a chaser right behind it. There is no rule of thumb and no "common sense" answer.

Medic/Nurse, BSN, RN · Sep 1, 2006

Go by the book, most of the time anyway. "Code" drugs, adenosine are pushed at more rapid rates.

On very slow IVP meds - I use the syringe feature on many pumps (plum) as a secondary with the drug diluted in 10 - 20 ml syringe/saline. It assures I won't go too fast, most drugs can always be "pushed" more slowly. (so it takes 5 minutes, usually not a problem- even if the book says you can do it two)

Also, I generally dilute all meds in 10 - 20 ml so that I can "push" slowly with greater ease/accuracy. I think trying to push 1 ml or 2 ml in 2-3 minutes a bit difficult (and if there are no fluids running, or if you are not flushing the line/lock along as you push the med - it is difficult to say just how much ends up in the circulation at any one time. Most extension sets have priming volumes from 0.4 ml to 2 ml - think about it).

Practice safe!

Elisheva · Sep 1, 2006

It's been a while since I've been in nursing but I'm scheduled to take a refresher course soon. This is the third of fourth time that I've read about diluting meds in of fluid before giving it but I don't ever remember anyone doing this on the floor years ago. I would assume that this is safe for all meds that can be injected through an IV port in which a fluid is already running. Will a drug reference book tell me if a drug can be diluted in fluids for push? My drug reference is not current or I'd check it out.

CRNAorBust · Sep 1, 2006

On our medical floor we have a preprinted list of all the IVP meds we have and how fast to push them. In our hospital we are NOT allowed to use the pumps secondary line to push mixed (diluted) push meds. Only those meds (antibiotics) that are premixed from the pharmacy. So consult your pharmacy to determine what can and can't be pushed via the pump AND at what rates you should be pushing particular meds.

Elisheva · Sep 1, 2006

Thanks, CRNA. I appreciate your response.

veegeern, BSN, RN · Sep 1, 2006

On our medical floor we have a preprinted list of all the IVP meds we have and how fast to push them. In our hospital we are NOT allowed to use the pumps secondary line to push mixed (diluted) push meds. Only those meds (antibiotics) that are premixed from the pharmacy. So consult your pharmacy to determine what can and can't be pushed via the pump AND at what rates you should be pushing particular meds.

After our latest inspection this became our policy, also. For instance, we nurses were mixing large dose of Zofran and putting them on a pump instead of standing there and pushing them "forever." Now, we split the dose and dilute it with 10 ml NS. The we push each syringe "forever." :rolleyes:

catlady, BSN, RN · Sep 1, 2006

On the ICU floor I work on several IVP meds are diluted in 50 ml bags of Nacl and then infused via gravity over 10-15 minutes. This would include Dilantin (100 mg doses), larger doses of dexamethasone (greater than 10 mg) and antiemetics like Zofran and Phenergan. This method is really convenient because the nurse can set the drip via gravity and then tend to other things as the medication is infusing into the patient at a safe rate. Beats watching the clock and "pushing forever"! Also is a safer method to use when a medication is a vesicant.

I would never want a Dilantin IVPB on anything but a pump, and the patient attached to a monitor that someone's actually watching continuously.

MQ Edna · Sep 1, 2006

catlady wrote:

I would never want a Dilantin IVPB on anything but a pump, and the patient attached to a monitor that someone's actually watching continuously.

I work in a neuro intensive care and basically 90% of the patients are on dilantin (100 mg) q6h for seizure prophylaxis. The protocol on our unit is:

-Direct IV push with doses of 100 mg or less, mix with 20 ml nacl and give slowly (50 mg/min) through filter tubing.

-Doses of 500 mg or less dilute in 100 or 150ml of nacl and give as direct (gravity) infusion (with filter) over 20-60 minutes. Most nurses I work with (and that I trained with) use this method over direct IV push even for the 100 mg doses.

-Doses over 500 mg dilute in 250 ml nacl and infuse (with filter) on pump (as primary infusion) over 60 minutes.

So basically we only use the pump when the dose is greater than 500mg (loading dose) and the volume is 250 ml, mostly to assure that the dilantin gets in within 60 minutes to avoid precipitation (which it is notorious for). For this reason Dilantin is always run on a dedicated line when using a pump and is never run as a secondary IVPB. Of course everyone in the unit is on continuous monitoring with alarms set appropriately.

It seems like dilantin makes you nervous? Have you had a bad experience?

If we had to watch patients in our unit on dilantin continuously throughout the infusion, the nurse patient assignment would have to be one to one!

So that's what it's like when it comes to neuro and dilantin, I know . . . we do things differently around here!!!

MIA-RN1, RN · Sep 1, 2006

can I add a related question to this thread?

When pushing, do you continually push very slow, or do you push a little/stop a little/push a little?

My question pertains to patients with saline locks. (If there is a line running already, I just pinch it, give a little, unpinch it, wait, pinch it, give a little, unpinch it, etc.) The meds I ususally give IVP are Nubain and Toradol.