IV Push Meds

https://www.ismp.org/resources/some-iv-medications-are-diluted-unnecessarily-patient-care-areas-creating-undue-risk

Because you need to forget what they taught you in nursing school. It’s not real world. The only meds that need to be diluted are vesicants. Narcotics do not need to be diluted if that’s what you were taught. Your MAR should have an order to dilute the medication and with how much. You should not be diluting without an order to do so.

You will also have an order on how fast to push something. These are mostly vesicant agents again.

For example, Pepcid is a vesicant. My order states to dilute with 3mL of sodium chloride and push over 3 minutes.

Zofran is another drug you push slowly. My order states to push over two minutes.

Pharmacy decides these things, not us.

1 minute ago, LovingLife123 said:

Because you need to forget what they taught you in nursing school. It’s not real world. The only meds that need to be diluted are vesicants. Narcotics do not need to be diluted if that’s what you were taught. Your MAR should have an order to dilute the medication and with how much. You should not be diluting without an order to do so.

You will also have an order on how fast to push something. These are mostly vesicant agents again.

For example, Pepcid is a vesicant. My order states to dilute with 3mL of sodium chloride and push over 3 minutes.

Zofran is another drug you push slowly. My order states to push over two minutes.

Pharmacy decides these things, not us.

Where I work, pharmacy doesn't provide any instructions anywhere about dilution or how fast to push things. It's really bugging me, and it's something I feel needs to change.

47 minutes ago, AlmostThere19 said:

I'm a new graduate who just started working. In nursing school, they taught us how certain medications had to be pushed over certain time frames. I also know that some meds are supposed to be diluted. When I've asked other nurses about what rate to push or if a med should be diluted, they always seem to not know or act like it doesn't matter. I am so confused by this. What is the right way to give IV push meds? I've looked up the directions for some meds in my drug book and plan to just go by that, but why does it seem like it doesn't matter how fast you push it or if it's diluted when I ask other nurses?

When you start working, ask the pharmacist where you can look this information up. Hospitals have this information more difficult to find than it should be.

Never, EVER trust what someone else tells you verbally...get used to looking them up or ask a pharmacist. You are responsible for compatibilities as well as dilution, infusion times.

In my experience, too many nurses are very sloppy on slow IV push meds. If it says to infuse for 10 minutes, then they are VERY serious about that.

Micromedex should be available or it may be built into your medication administration system. The pharmacist should know.

1 minute ago, Jory said:

When you start working, ask the pharmacist where you can look this information up. Hospitals have this information more difficult to find than it should be.

Never, EVER trust what someone else tells you verbally...get used to looking them up or ask a pharmacist. You are responsible for compatibilities as well as dilution, infusion times.

In my experience, too many nurses are very sloppy on slow IV push meds. If it says to infuse for 10 minutes, then they are VERY serious about that.

Micromedex should be available or it may be built into your medication administration system. The pharmacist should know.

Thank you! We do have micromedex, and I've been able to find compatibility information but nothing about dilution or push times. I need to dig around the website more and figure out where it is.

11 minutes ago, LovingLife123 said:

Because you need to forget what they taught you in nursing school. It’s not real world. The only meds that need to be diluted are vesicants. Narcotics do not need to be diluted if that’s what you were taught. Your MAR should have an order to dilute the medication and with how much. You should not be diluting without an order to do so.

You will also have an order on how fast to push something. These are mostly vesicant agents again.

For example, Pepcid is a vesicant. My order states to dilute with 3mL of sodium chloride and push over 3 minutes.

Zofran is another drug you push slowly. My order states to push over two minutes.

Pharmacy decides these things, not us.

I completely disagree. When I still worked the floor I diluted narcotics on a regular basis for various reasons. If it is compatible with saline or sterile water, you don't need an order to dilute it. That's ridiculous. That's like getting an order to use a flush.

You are more likely to give the correct dose and clear the port, especially for very small administration amounts (common in peds) if it is diluted.

Pharmacy generally doesn't decide that either. It is evidence based protocols like anything else and there should be a written system that every nurse has access to 24/7 that gives medications. You can't blame pharmacy if you get it wrong.

I'd recommend looking up the common meds on your unit in your drug manual from nursing school if you still have it. The manual will clearly identify any special preparations (dilution, roll instead of shake, etc.) and the rate of administration. Sometimes, in addition to rate of administration, it'll list a rationale, like may cause hypotension, arrhythmias, etc. of administered too fast. Others specify instructions like "do not exceed 5 mg per minute" instead if a time frame. Like others said, Micromedex could offer you the same if you don't still have your drug manual.

It's nice if the previous poster's hospital offers guidance on medication prep and administration in the MAR, but this is not routine. Neither of those factors is a required component of the physician's order. It's also not pharmacy's responsibility to educate the nurses on administration of each med (although they're a great resource). These are nursing considerations, so they're a nurse's responsibility to find out before administering the med.

Please disregard the poster who said "you need to forget what they taught you in nursing school. This is the real world." Yes, it is... and the real human lives that are relying on you to provide evidence-based best practices to avoid harm would like you to remember what you learned in this case. Barring a code situation, rates of administration should absolutely be followed. To say that's not reasonable for a busy nurse is really just crap. Make time. It's not fair to patients to receive subpar, potentially harmful care just because their nurse is in a hurry or the unit is understaffed. Medication preparation instructions and administration rates weren't just willy nilly thrown into random pages of drug manuals to throw nurses off, and to act like that's the case by instructing someone to ignore them demonstrates a lack of knowledge, in my opinion. That's not someone I'd want caring for myself and my loved ones.

Remember, you may be a new grad, but you are already an RN and held to RN standards. That means YOU get to choose how you're going to personally do things, even if the rest of your unit doesn't follow a best practice, because you have a license and a duty to your patients. Good for you for speaking up, asking questions, and wanting to do things the right way!!

All answers have a kernel of truth, it can be overwhelming.

Take it one baby step at a time. Pick one or two drugs you frequently give IV push and read, Google, ask here, etc., the best practice for giving it IV push.

Get those two drugs down pat and move on to two more.

The worst thing is the best practice can vary. Four mgs of morphine given to a chronic pain patient may be, will be, given differently to a patient who's never had any narcotics.

Pretty soon you will be our go to expert on IV push meds ?.

your medication administration orders should give you parameters for how long to give a medication over.

On 9/21/2019 at 5:56 PM, Jory said:

Never, EVER trust what someone else tells you verbally...get used to looking them up or ask a pharmacist. You are responsible for compatibilities as well as dilution, infusion times.

Best advice, here. You'd be surprised at how many people will answer a question that they don't actually know the answer to. Look up the answers, yourself. The pharmacist is a good resource when the answer is unclear.

I've found that dilution (when not absolutely necessary) seems to be a regional preference.

Just push it... push it reeeaal good