IV Push Questions from nursing student

turnforthenurse, MSN, NP · Jul 18, 2010

If the infusion is NOT compatible with the med you are pushing, you need to STOP the infusion. Flush the site with 0.9% NS (to clear the line) - depending how much you flush depends on institution policy. Inject your med, then flush again with NS.

Generally if the IV site is running and appears patent, there are usually orders (generally on the MAR) that state to flush the site, usually q12h (but sometimes q8h), but I have had both instructors and nurses tell me that sometimes they won't flush if the IV site is in use and will simply document, "IV site in use." I mean, why flush with NS when you already have NS running? You don't want to always flush the line "just for good practice" because you're giving the client more volume and even tho they are small amounts, you could send them into hypervolemia! Also remember that even though it's just NS, anything that goes into a vein is still a med and unless there is an order, I wouldn't flush.

glovedgoddess · Jul 19, 2010

Thank you =)

nicetomeetyou · Jul 24, 2010

If IV fluids are running, I always flush before and after regardless of compatibility... there are usually standing orders that say "to flush before and after administration of IV medications" and I hardly ever have a patient who is just running normal saline. Its usually with potassium and some drugs are not compatible with K.

turnforthenurse, MSN, NP · Jul 24, 2010

If IV fluids are running, I always flush before and after regardless of compatibility... there are usually standing orders that say "to flush before and after administration of IV medications" and I hardly ever have a patient who is just running normal saline. Its usually with potassium and some drugs are not compatible with K.

Yes this, always check what fluids you have running...but there have been a lot of times where I have patients with just NS running at a KVO rate or something.

mammac5 · Jul 24, 2010

If the patient has NS running, there is no need to flush with MORE normal saline. You could...but you need to remember that everytime you access that line for any purpose, you run the risk of introducing pathogens. So don't do it if it's not needed.

I think the reason some nurses routinely flush is because it's quicker/simpler than looking up the meds in question to check compatibility, but again this would only apply for fluids that are NOT NS since that's what you would use to flush. Hope that makes sense.

nicetomeetyou · Jul 24, 2010

We flush before and after administration of an IV push because thats the protocol at my hospital. Ofcourse it's different everywhere, and obviously if you had a fluid restricted patient they most likely wouldn't have fluids running anyway.

Asystole RN · Jul 25, 2010

Hi there, I was just wondering if anyone could help me out with some concerns I have with IV push. I have tried to get clarity but some nurses are not very helpful with giving rationale for the things that they do..
When giving IV push:
-> If an IV infusion is running, do you only stop the infusion if med is NOT compatible with running solution??
**I assumed you always stopped the infusion, one RN told me I didn't have to??...Why wouldn't you always stop the infusion?? Wouldn't leaving it running affect the infusion time you are administering the IV push med?

When pushing a med always stop all infusions that are running into a Y-site unless running into a multi lumen PICC.

Never push meds into an IV line, doesn't matter if it is compatible or not.

The rationale is to prevent med errors, and to gain greater control over the push time.

-> If IV infusion is running and IV site appears patent, should you still use SAS method just for good practice?
*Shouldn't you always flush pre and post, even with a running IV infusion because you would want to clear the port?? My instructor told me that you use your common sense and don't have to flush because the running infusion will do the flushing for you (yes, but what about the port??)
Sometimes I tend to overthink the skills, but I always like to know the reasons behind the actions!
Thank you for your replies, very appreciated. :)
I will have many more questions throughout this practicum!

Yes, always flush before and after. Not only does it prevent med errors it is a good habit to get into. Flushing does more than clear medication from the line. It opens the veins and clears obstructions that an infusion would not.

A 75ml/hr drip will not flush a line the same way a 10ml/10second flush will (equivalent to 3,600ml/hr infusion)

P.S. made me think of a trick in IVs for you. Should you have someone with tiny constricted veins and am having trouble getting anything larger than a 24g in, put in the 24g and flush the site. Opens the larger veins downstream so you can thread a larger gauge cather. Use this mostly on dehydrated patients.

Asystole RN, Infusion Therapy

turnforthenurse, MSN, NP · Jul 28, 2010

P.S. made me think of a trick in IVs for you. Should you have someone with tiny constricted veins and am having trouble getting anything larger than a 24g in, put in the 24g and flush the site. Opens the larger veins downstream so you can thread a larger gauge cather. Use this mostly on dehydrated patients.

Thanks for this! I will keep this in mind :)

Schweet · Jul 31, 2010

P.S. made me think of a trick in IVs for you. Should you have someone with tiny constricted veins and am having trouble getting anything larger than a 24g in, put in the 24g and flush the site. Opens the larger veins downstream so you can thread a larger gauge cather. Use this mostly on dehydrated patients.

That's a good tip, thank you!

aCRNAhopeful · Jul 31, 2010

Real world answer: Just push it into one of the Y ports higher up on the line and let the pump carry it in. Of course you have to make sure they are compatible first and of course you dont want to do it with meds that NEED to be given carefully. Lasix comes to mind as one that needs extra caution to give slowly, same with something like a cardizem loading dose. But since you are still a nursing student I would make sure that you push every med over the "correct" amount of time to avoid getting in trouble.