IV pushes

[#NurseB]

I'm just wondering how you all do your IV pushes. I'm a new nurse and spend a great amount of time doing 2-3 minute pushes for my meds as I have been taught.

I worked with a new nurse today that told me when giving a push through the proximal Y-site with fluids running wide open, she just slams it in because the tubing holds approximately 2 mLs and the pt will get it slowly enough.

I'm wondering how many use one or the other methods. Thoughts?

Thank you!

[SubSippi]

For me, it depends on both the patient and the medication. If I think a patient needs or can handle a fast push, I do it fast. I'll let fluids push it for me sometimes. With a really fast acting medication and/or an unstable patient, I'll do a little at a time to see how they handle it.

[Karou]

Always go by the pharmacy recommendations and guidelines for how fast any medication should be given.

"Slamming" every med into running IVF is really bad, very unsafe practice. Depending in different factors the patient could be receiving the medication either too slowly or too fast. Factors like, is it diluted in a 10cc NS flush first? What is the volume (mL) of the med you are giving? Which port is it being given in? Is it compatible with the running IVF? What rate is the IVF infusing at? Is this medication a vesicant? Most important factor is knowing what the medication is.

I will often administer medication through running IVF, considering all of those factors. I never "slam" anything.

[Tenebrae, BSN, RN]

Not the best way to protect the vein is it?

Slamming a push into the veins of someone with dodgy IV access at the best of times is not going to make a nurse popular with their colleagues who have to make multiple attempts to resite IV access because the last nurse put the IVAB through too fast and blew the vein

My 2cents worth I dont work with IVs on a regular basis someone with more experience may disagree

OP, the first time that nurse has a patient get profoundly hypotensive after "slamming" a med, I'll guarantee you that s/he will change his/her practice.

[nonnocere1988]

Lol don't "slam" IVP. Very bad practice.

[been there,done it]

Slamming is not acceptable practice. Does this nurse work in an ER? Some ER nurses feel this is the ONLY way to go.

Please discuss this with your pharmacy and nursing education department.

I would report this.

[icuRNmaggie, BSN, RN]

The only time I that I do fast IV pushes are for rapid sequence intubation, narcan, and ACLS code drugs.

Whether or not you are giving the medication through a running maintenance fluid is irrelevant.

You need to look up how fast to give an IV dose for each medication, it is not called a push, it is "IV over one ( or two or five) minutes.

Look it up until you have it committed to memory.

[cp1024]

I'm so glad that the responses confirmed my initial thoughts. I've only been a nurse for a week, but I read the OP thinking "OMG, s/he's going to kill someone..." Glad to know that not all nursing school knowledge is useless! It is hard to know the difference between what is "text book" and what is "real world" sometimes.

[wanderlustnurse88, RN]

If I can for those 1-5 min administration times, I will attach the syringe to the IV pump as if I was running a secondary line so that it is given in an accurate time frame. I find it hard to stand there and push over the recommended time as I either end up going too fast or slow.

[icuRNmaggie, BSN, RN]

I vaguely remember working with a pump that had that function. It was a nice feature. Was it the Plum pump?

[annie.rn]

If I can for those 1-5 min administration times, I will attach the syringe to the IV pump as if I was running a secondary line so that it is given in an accurate time frame. I find it hard to stand there and push over the recommended time as I either end up going too fast or slow.

I do the same thing. It is especially helpful for IVP antibiotics and Phenergan.

To the OP: here is another reason why your preceptor's technique is poor practice. Once she has "slammed" the whole volume of medication into the Y-site, it is on it's way in to the pt. and cannot be stopped (unless maybe you unhook the I.V. in time and flush out the line). It's important to give meds at the prescribed rate b/c you never know how a pt. might tolerate them, esp. if they have never had the med before. I like to give IVP meds slowly and watch the pt. carefully for any sign of adverse rxn. If I see any kind of rxn., I am able to stop the administration of the medication.

As far as things being textbook vs. "real world", I don't think there should be any "real world" way when it comes to medications. These drugs are studied extensively and there is a reason why they tell you how fast to administer them. This reason is based on research and the rates ("textbook way") need to be followed.

Don't lose your idealism. It's easy to fall into sloppy practice. I see it all around me day after day. It's difficult to not take shortcuts when you are stretched thin but find your shortcuts in other places, not your med pass.

Good luck to you and thanks for wanting to do things the right way.