IV Push meds

[RNNC2003]

OK, I'm a new grad and with everything being thrown at me so quickly, I find myself second guessing everything I do, and I mean everything, even the simplest things... Can someone clarify a few things with me?

1. When pushing a med through an IV port (there are fluids running), do I need to flush it through still, even though there are fluids running?

2. When I flush a heplocked IV, it is always so hard to get the flush to flow. If I try to aspirate to see if I get blood return, 99% of the time I don't get it. Then when I try to push the saline through, it's really hard to push through, almost as if it's clogged. So when I push harder, it eventually goes through, but the patient acts like I'm hurting them. What am I doing wrong?

3. If a patient has a stage 1 or 2 pressure sore on their sacral area and a duodern has been applied, how often do we need to change the duodern? Every shift, or prn?

4. We have a lot of elderly patients with some type of dementia/ alzheimers. They have a tendency to go crazy on the midnight shift. If they have something ordered for prn pain, is it OK to give it to them to calm them down? I had one the other day that was in a posey vest restraint, but still somehow managed to throw her legs over the side rails and hang off the side of the bed every 15 minutes. She was totally disoriented and seeing things.... My preceptor said to give her a Darvocet to calm her. (It was listed as a prn pain med). She said it would be OK even though the patient didn't verbalize pain, because a lot of elderly people act out when they're in pain, versus just telling you.

Thank you for any help!!

[Noney]

1. If you feel like part of the medicine is staying in the port go ahead and follow it with a flush, it won't hurt anything. Our tubing doesn't require that but yours might. Ask some of the other RN's at work.

2. If you have to use a lot of force to flush a SW then it's probaly clogged. It needs restarted. I never force a flush though. One thing I've noticed is that if I can't flush the first time, I'll unhook the syringe and rehook, sometimes it helps. Another thing if it doesn't flush easy pull the SW towards you a little with gentle pressure and try flushing while pulling towards you. If the SW is in a wrist try reposition the hand and wrist. How often are you flushing your SW's? They may just need flushed more often. We flush with 3cc's NS every shift.

3. Duoderm can be left on 3-5 days according to you policy. You definitely do not want to change them every shift or even daily.

4. Dementia/ alzheimer's pt's will have all sorts of behaviors when in pain. If you have a pt in a posey hanging over siderails TAKE THE POSEY OFF and LOWER THE RAILS. This type of pt needs 1-1 care or a low bed with alarms. If you know a pt is hanging over the rails in a posey and leave them in that situation and that pt gets hurt. YOU CAN LOSE YOUR LICENSE. and the PT COULD DIE. I would probaly call the doc and wake him up in that situation. Yes a darvocet might help but will take awhile to kick in and in the mean time the pt is in danger. Sorry if I am coming off like a B@#$% about this, but it truly is dangerous. Never be afraid to call a Doctor if you pt is in danger.

Hope I helped

Noney

[Reabock]

Good answers, same as we do here, especially about flushing the saline locke site. If it flushes that hard I'd be afraid I was pushing a clot thru and would cause a problem, so usually restart the site. I also rarely get a flashback unless it is in a very large vein or an antecube site.

Side note, we had a pt come from ER with a foot site tonite, don't see that too often!

[melbnurse]

Posey restraints are now illegal in Australia , for about 7 years I think! DONT ever leave a patient restrained in any kind of restraint , if it is likely to hurt them.

Dementia patients are unable to localise pain, nor express it , so it is totally correct to administer pain relief as ordered , if they are disturbed .

As for the IV drugs , don't ever " force " a flush or a drug , if it needs forcing , it needs resiting

[meownsmile, BSN, RN]

I ALWAYS flush a IV port before i push a med. It clears all previously given meds that may be incompatable with what you are giving. Working in med/surg it isnt always clear what the port was used for prior to my administration. I've come across ports that werent flushed in OR and still have remnants of Ketamine and other drugs in them, so if i flush i am insuring that my patient isnt going to get a dose of precipitated medication. I always flush afterward also to ensure they have the full dose of what im giving. I know the ports dont hold much, but if you have ever flushed and had a cloudy preciptate show up that youve had to withdraw you dont ever question flushing first again.

And when we do get the cloudy precipitate show up post-op we are required to write it up. One of our QA's for the quarter.

As for the lock being hard to flush. Dont force, try having the patient reposition their arm, try repositioning the lock slightly and see if it is easier. It could be that it is against the side of the vein making it hard to push. dont force it though, if repositioning doesnt work,, restart.

[Paige Turner RN]

do you flush even if there are iv fluids running? If there are iv fluids running or tpn is running do you still do the q shift flush?

[Erin RN]

If there are IV fluids running you shouldn't have to flush. As far as TPN, every place I have ever worked and when I did IV infusion..TPN had its own seperate line..we NEVER pushed any meds into the TPN line..it is incompatible with too many things.. I would check on hospital policy. As far as the forcing issue. I just reviewed a case where the RN "forced" the calcium chloride and the guy ended up having to have grafts and everything since the IV that it was "forced" into was infiltrated..it was a real mess..the arm was necrotic within 8 hrs...yuck!!

[RNNC2003]

Thanks for everyone's responses!! I know most of my questions sound stupid, but I'm new, so I figure asking stupid questions is part of the game. Everyone has been so helpful!!! Thank you!

[Spidey's mom, ADN, BSN, RN]

I've never flushed after a med in a running IV unless it was an ACLS drug in the ER.

Flushing shouldn't be difficult. You've most likely infiltrated but sometimes you might be against a valve and pulling back a little at the hub might help. Otherwise, be safe and restart.

steph

[Jay-Jay, RN]

I wound up in the ER a couple of years ago with acute abdominal pain and vomiting. After waiting for 3 hours, the nurses FINALLY got the stupid ER doc. to give me something for pain. I guess he figured I'd suffered long enough, 'cuz they gave me Demerol IV push! It burned like liquid acid. The nurse temporarily opened the control wheel on my IV line full to flush it through [thank you, Nurse!!]

I reported the doctor. By that time, I was running a fever of 104, and hadn't even had an IV started on me yet. I had to ask three times for something for the fever/pain. Each time the nurse went to the doctor, and he blew her off (yeah, yeah, in a while...I'm busy!) The third time, he threw a temper tantrum, swore, smashed a stack of charts down on the nursing station desk, then finally snarled out a verbal order for me.

Oh my, are we having a bad night???

[kimmicoobug]

I am a new nurse, as well. So far, one of my iffy questions has been. If the patient has an elevated temp. You have had them cough and deep breathe and still the temp is still elevated, they have no Tylenol ordered, MD has no standing orders. Would it be ok to give them a tab of Vicodin (which is ordered) to help lower the temp or would calling for Tylenol be more appropriate (oh, let's say this is with the 0400 vitals).

Here, we don't run anything with TPN, we don't do line draws if TPN is running, we don't flush after pushing meds through an IV line (but I guess it wouldn't hurt...I have done it from time to time if the rate is lower). I do not force a flush because the site tends to be bad. But, I have had saline locked IV's infiltrate after a good flush.