IV pushes

cp1024 · Dec 10, 2014

I personally, don't see myself ever being lax with drug administration. But so many times in clinical, and sometimes even instructors, would tell us that "that's how the book says to do it, but it's not done that way in practice". Which leaves the question, How can I know the difference? Personally, I try to look at the "why" behind the procedure as opposed to "this is how they told me to do it" and I think focusing on the theory behind it will help me to, hopefully, identify poor practices once I am on the floor working and not harm someone. But I do worry that I'll make a mistake and not realize it, because we are given so much conflicting information.

icuRNmaggie, BSN, RN · Dec 10, 2014

If your pt has an order for 80 mg of IV furosemide, it is a good reason to pull up a chair, sit down and do a little pt teaching on heart failure while you give the med over 8 minutes.

Long Term Care Columnist / Guide · Dec 10, 2014

I've never "slammed" an IVP drug except during a code. Some meds, like Phenergan and Ativan, are very viscous and need to be diluted, and even then they should be pushed very slowly to avoid discomfort for the patient and/or blowing the vein. Besides, as has been stated before, it's good to keep an eye on the patient during administration to see if they have a bad reaction to the drug being pushed so you can stop it in time.

I didn't know there were IV pumps that can administer IVP drugs in a controlled manner. Shows you what being out of Med/Surg for nine years does to a person! :yes:

**NickiLaughs, ADN, BSN, RN** · Dec 10, 2014

I've made the mistake of slamming meds on patients a couple times when I was in a hurry, one time, they were ok, another time they bradyed down to the 30s with the entire 1 mg of IVP morphine I gave them (grown man, narcotic naive). I dilute all my pushes in a 10 CC saline flush and tape the bottle to it (to discern from a regular flush when I give meds.)

I've also had 0.25 mg of Dilaudid slammed into me when I had my son. My initial reaction was I thought I was going to die, and then I threw up all over the place (thankfully I missed my son). I snapped and said, "Never give me that again." I think the nurse though I was going to assault her. I wasn't, but my experience was that slamming narcs is never a good idea.

NP2BeNY · Dec 10, 2014

As others have said, you shouldn't slam anything except Adenosine. While you need not go to an extreme and give say, 4 mg of Zofran over 5 minutes, it is reasonable to give it over a minute or two. Again, as other posters have said there are guidelines for each of the meds we give.

NP2BeNY · Dec 10, 2014

I've made the mistake of slamming meds on patients a couple times when I was in a hurry, one time, they were ok, another time they bradyed down to the 30s with the entire 1 mg of IVP morphine I gave them (grown man, narcotic naive). I dilute all my pushes in a 10 CC saline flush and tape the bottle to it (to discern from a regular flush when I give meds.)
I've also had 0.25 mg of Dilaudid slammed into me when I had my son. My initial reaction was I thought I was going to die, and then I threw up all over the place (thankfully I missed my son). I snapped and said, "Never give me that again." I think the nurse though I was going to assault her. I wasn't, but my experience was that slamming narcs is never a good idea.

Just out of curiosity why do you dilute anything except opiate pain meds?Do you dilute toradol, zofran, Ativan, etc?

icuRNmaggie, BSN, RN · Dec 10, 2014

The FDA and the manufacturer( GSK) both recommend that IV odansetron or Zofran 4 mg be administered over two to five minutes to prevent QT prolongation and bradycardia.

icuRNmaggie, BSN, RN · Dec 10, 2014

The carpuject prefilled syringes of lorazepam, hydromorphone and morphine sulfate can be given undiluted by the IM route.

The 1ml doses of these medications are dispensed in a 3 ml syringe so that the medication can be diluted with an equal amount of a compatible diluent for IV administration as per the manufacturer and FDA recommendation.

Ketorolac comes both in prefilled syringes and vials for IM and IV administration. There are no recommendations for dilution for IV administration.

That Guy, BSN, RN, EMT-B · Dec 10, 2014

Ketorolac comes both in prefilled syringes and vials for IM and IV administration. There are no recommendations for dilution for IV administration.

I try to dilute toradol whenever possible, even if it is just at the y-site 2 syringe push just because it can burn something awful going in.

icuRNmaggie, BSN, RN · Dec 10, 2014

I mainly give ketorolac to post op patients with running IVF. I have not heard anyone complain of burning but I will keep that in mind for the future. Thank you.

IVRUS, BSN, RN · Dec 11, 2014

I agree with the post that says Adenosine is the only drug that needs to be "slammed", and that's because of its short half-life. However, All medications need to be assessed for the correct administration time. Pushing anything too quickly can cause Speed Shock. Yes, hypotension is a S/E... and you do NOT want a cardiac patient, with a weak heart to become hypotensive as you may not have the ability to get that heart rate back up in time.

Please check your drug book, or call a pharmacist if you don't have the administration time memorized.

Graduatenurse14 · Dec 11, 2014

I learned a ton from this thread!!

The FDA and the manufacturer( GSK) both recommend that IV odansetron or Zofran 4 mg be administered over two to five minutes to prevent QT prolongation and bradycardia.

I have seen Zofran given quickly and didn't realize that was a big no-no.

The carpuject prefilled syringes of lorazepam, hydromorphone and morphine sulfate can be given undiluted by the IM route.

Didn't know that either though it makes sense physiologically. Is this done mostly in trauma situations when a line isn't placed yet or can't be placed?

THANKS!