iv push ?

You could do both. Generally if you stop the fluids and do a flush of 10cc at the port closest to the patient you should have the line cleared well. You can then give the medication and flush again. Just remember to pinch above the port you are using at all times. You could also completely disconnect the IV tubing, flush the IV, give your med, flush again, and then reconnect. That's a big time waster but if you are really concerned it's another way to do it. Check your facility's policy and follow what they say.

I am an err on the side of caution girl, (I saw a nurse push Dilantin in a line that wasn't cleared of D5 1/2 all the way, and it precipitated really fast, scary! She stopped pushing and disconnected the line from the pt, but it was close) so I always take it apart at the site, flush, push the med, flush, and then reconnect. Previous poster is right though, it takes longer. And you should definitely check your facility's policy.

Best way to handle this is give it at the T-extension at the site or if using an intima give at the y-site of that device...these are the closest you can get to the cannula and it totally avoids the problem of disconnection and reconnecting. You really should try to avoid disconnecting and reconnection b/c you need to keep the number of these actios low as it will increase potential for contamination. I would rather add the extension set at the time of the start if using that type of device or add it if someone else did not. Yes......... some drugs stick to the tubing and if not flushed adequately will precipitate. So just remember:

S.....Saline

A.....agent

S.....saline

H...heparin (if its locked off

We don't use heparin anymore on "hep-locks", just saline. I guess some places still you heparin? We do use it in our Quiton caths, but sometimes not even then due to HIT or if pt is coagulopathic.

But back to the topic :) If it's not a compatible drug I disconnect, fluch, give med, flush, and reconnect. I dont' want to take the chance of the drugs mixing if they're not compatible. That's just me.

You could do either, but I prefer the first.

A few thoughts:

* I'm an ED/ER nurse. If I suspect a patient will need multiple medications, I start more IV sites. Problem solved

* If a med is absolutely contraindicated, then I hold the infusion and disconnect the line, flush with 10 cc saline, flush the med, flush with 10 cc saline and then re-connect the IV infusion.

* If there is no absolute contraindication, I pinch the line above my port and administer my med through the port and then resume IV fluids (or sometimes I run the fluids while I slowly administer med through a distal port - helps dilute meds before hitting the pt.... only contraindication being rapid admin meds like Adenosine, Epinephrine etc.)

HOWEVER, bear in mind that in the ER/ED, 99.90% of the time the IV fluid in use is Normal Saline. It's very rare that we come across meds incompatible with saline during administration.

Of the 0.10% of the time when we might have incompatible solutions, I save myself the hassle of a messed up IV site (not to mention the extra paperwork!!) and just : "disconnect, flush, med, flush, reconnect".

cheers,

i love the "sandwich" method. i use this consistenly, i always do this, with everything.

Its the little things we learned! lol

-H-RN