IV push timing?

[molliemiko]

Hi,

I was just wondering about the timing for IV push medications. Say you're pushing a med that's only 1ml (say solumedrol for example).. when do you start timing the push? Most peripheral IV tubes are 3ml's and PICC's/midlines, I think are about 10ml's, before they even hit the vein. So, do you push the 1ml medication in at a normal pace, add 2 more ml's of NS at a normal pace, and then start timing with the remainder of the flush instead of the med if it's a peripheral IV?

[Postpartum RN]

I had this exact question when I was orienting, and I remember my preceptors answer was something like this, mumbled, "oh um yeah makes sense" and my other preceptor said "huh?" So I never really got an answer. Sometimes there's a tiny bubble that's visible when you start pushing a med through the nearest port, if there is then I try to watch it when it hits the vein and then I start my timing. If I don't see then I just push slowly..I always push my flush very slowly as well as the med in the tube is still going in..hope this helps

[molliemiko]

Yeah, it just seems weird to time a small amount of med that's probably just sitting in the line anyways. Then, to flush it quick seems like it would make the whole timing thing pointless. Thanks for your response. I have a hard time getting a straight answer, too. So, I feel like I waste more time than I should with pushes because I tend to time the med and the flush just to be on the safe side.

[shedevilprincss]

We add small amounts of med that need to be timed (i.e. Solumedrol) to a 10cc flush. Much easier to time.

[BeachsideRN, ASN]

Same. We are taught to dilute in saline flush then push over time. Because if you infuse the whole 1ml then flush you just pushed a bolus into the vein defeating the purpose of timed push

[IVRUS, BSN, RN]

Most PICC's hold a total of 1 to 1.5 mls. PIV's hold a fraction of that. The timing should begin once you start the push the medication into the vein. And remember, that once it hits the vein, it takes approx. 23 seconds before it is everywhere in the body. How long the medication is to be pushed, depends totally on the drug. Adenosine, for instance, is pushed over 2-3 seconds... However, most others have a certain amount of mg or mcg to be given over a certain time frame. Don't know what that time frame is? Check your drug book, or call your IV RPh.

[canigraduate]

You give the med at a slow rate and you give the follow up flush at a slow rate for as much as it takes to clear the tubing. If you are using the port closest to the patient, that's about 3-5 mLs. You can push the rest of flush as fast as you want. You start the time as soon as you start pushing the med.

The purpose of timed pushes is not to irritate the veins with large amounts of irritant medications.

In practical terms, if you are giving a med with a 2 minute push, that's from start to finish of the med. You still flush slowly, but it doesn't count as part of your time because you could inadvertantly start up some thrombophlebitis by giving the med too fast.

I hope that helps.

[IVRUS, BSN, RN]

After giving a IVP medication, the flush solution should NOT be pushed into the IV catheter at any ol' rate. It should be given at the same rate that you were giving the IVP medication.

[canigraduate]

After giving a IVP medication, the flush solution should NOT be pushed into the IV catheter at any ol' rate. It should be given at the same rate that you were giving the IVP medication.

Yes, that's what I said earlier. You flush enough to clear the tubing at the same rate. After that, it doesn't matter. The med's in.