IV Push Practice

MAISY, RN-ER, BSN, RN · Sep 18, 2007

Don't know of any websites, but when you are working in a facility they will have guidelines regarding iv push medications. Also, since I work in the ER I always refer to my med book-it's always better to be safe than sorry!

Maisy;)

TazziRN, RN · Sep 18, 2007

Formula? There's a formula?

I understand that you need something concrete for your preceptor, but in practice it's pretty simple: when in doubt, push it slow. The only med I can think of off the top of my head that you absolutely MUST push as fast as possible is adenosine. If it's a cardiac drug or has cardiac side effects, it probably needs to be pushed over at least 5 minutes. The only time this does not follow is in a code.

MAISY, RN-ER, BSN, RN · Sep 18, 2007

Almost forgot, sometimes meds require a long push over 2-4 minutes. We push a gram of Rocephin-it's 10mls-if the patient is old, fragile, bad veins, precarious iv I will hang as a piggyback in 50ml, we do the same with Pepcid and other drugs. Even iv push morphine or dilaudid is a judgement call in the ER. If the patient is opiod naive, old, or very sick- a push could be over a long time, or put in a bag to hang. Sickle Cell or cancer patients will get the push. Hope this helps.

Maisy;)

Deb123j · Sep 18, 2007

We learned in cardia that there is a formula. I'm pretty good in math (can figure a lot of things out in my head) but I couldn't and still can't wrap my head around this formula.

mL / seconds = 0.1 or 0.2 / x

Example:

Order: Give Demerol 25mg IV now

IV Drug Guide: If dose 25mg give over 3 minutes

Available: 50mg/ml vial

0.5ml / 180 seconds = 0.1 / x

18 / 0.5x = 36

Answer: Give 0.1ml every 36 seconds over 3 minutes

GregRN · Sep 18, 2007

We learned in cardia that there is a formula. I'm pretty good in math (can figure a lot of things out in my head) but I couldn't and still can't wrap my head around this formula.
mL / seconds = 0.1 or 0.2 / x
Example:
Order: Give Demerol 25mg IV now
IV Drug Guide: If dose 25mg give over 3 minutes
Available: 50mg/ml vial
0.5ml / 180 seconds = 0.1 / x
18 / 0.5x = 36
Answer: Give 0.1ml every 36 seconds over 3 minutes

I'm guessing you also learned that meds have a therapeutic range. That is, they have a range of dosages in which it will provide benefit without side effects. You'll also find that drugs have a range of acceptable delivery dosages and times: 5mg metoprolol IVP over 1 minute is as acceptable as 10mg metoprolol IVP over one minute. Point being, your above example is accurate, but not necessary. Giving 0.1ml every 36 seconds: how will you know that you're giving exactly 0.1ml? Is the syringe you're using marked such that you see easily what 0.1ml looks like? And every 36 seconds: are you going to measure that exactly as well so that the first push goes in at exactly 8:00.00 am, the next at exactly 8:00.36 am, the next at exactly 8:01.12 am, etc.? With meperidine (Demorol) you can probably put it in a 1cc syringe and it will be marked with enough detail that you can measure it to exactly 0.1ml. But it's not the case with other meds and you'll drive yourself nuts with trying. So, givng the med at a consistent rate that will infuse the med in the recommended time range is the key, not necessarily an exact dosage at an exact time. Again, this is because meds have a range of acceptable values.

In the times where it is absolutely necessary that the med be given in the exact nature you describe above (pediatric doses immediately come to mind) you'll find that most meds will be given through the use of a pump. Having an understanding of how to compute the dosage given per length of time will allow you to verify if the pump is programmed correctly. The only formula you'll need for computing this is prescribed dosage divided by time. Done.

bellehill, RN · Sep 18, 2007

I don't have anything concrete in writing but a general rule I follow is 1cc/1minute for most drugs. Labetalol, Metoprolol, Hydralazine, Dilantin, Zofran....they all mix to 1-5cc and need to be pushed 1cc/minute. Like Tazzi said, when in doubt push slow.

LeesieBug · Sep 18, 2007

I am very relieved to see that I am NOT the only one that was thinking

"Formula.....what formula?"

I take a syringe c one ml in it, look at my watch and just evenly dose it out over two minutes(for example)......never in 4 years of school and over a year out on my own new some people learn and use a formula.

Never learned a formula for this in peds either. Anything that needs to be that precise was pumped.

As far as the push time, when in doubt I ALWAYS check the book.

Deb123j · Sep 18, 2007

This is ALL very good news to me!!!! lol I HATE that formula that they gave us...never made sense!

It is much easier for me to figure it out in my head how much to give over how much time.

In answer to GregRN...that is exactly how they wanted us to give the meds in cardiac. 0.1 @ 08:00:00, 0.1 @ 08:00:36...etc. They had us scared to death we would kill a patient if we did it any faster. Our syringes at the hospital have lines were you can see exactly how much you are giving at a time.

RNsRWe, ASN, RN · Sep 18, 2007

Most of the meds you'd push would be slow, about 1 mg/minute. Lopressor (Metoprolol), a 5 mg dose, should take five minutes. Faster and you could bottom someone out.

Narcs? A mg a minute. Lasix? A mg a minute.

Seeing the "formula" there? Seriously, I'm only outta school less than a year and a half, and there was no "formula" that made any sense, but common sense always works: if the drug book says to dispense it over three-four minutes, do that. If it says over five minutes....look at the watch, use the opposable thumb, and do it :)

P_RN, ADN, RN · Sep 18, 2007

Lasix a MG a minute? or a mil a minute? I've given as much as 240 mg of Lasix at a time(too fast and you can cause deafness) but 240 minutes is waaaaay too slow. Frankly eyeballing it has always served me well. When in doubt call the pharmD for your floor. That's why they have the D after their degree. They are a great resource.

purple_rose_3 · Sep 18, 2007

I usually refer to an IV drug book or call pharmacy if I'm unsure of how fast to push something.