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!

[icuRNmaggie, BSN, RN]

IM lorazepam is often given in psych and the ER. Since the ER and EMS will place an IO if they can not get IV access, and since PICC lines are pretty much standard with pts needing a central line for TPN post op, I have not seen morphine or hydromorphone given by the IM route in a very long time.

[icuRNmaggie, BSN, RN]

One thing that is commonly ordered and totally contraindicated according to the literature is the practice of giving IV metoprolol to an MI patient on a diltiazem drip.

Please look it up and question that order.

I have seen asystole occur immediately after the first cc of metoprolol, even with the diltiazem gtt on hold. Both are AV nodal blockers.

It is an extremely dangerous practice to give both to a person with an MI. The treatment when they code is calcium chloride, along with the ACLS protocol.

[wanderlustnurse88, RN]

IM lorazepam is often given in psych and the ER. Since the ER and EMS will place an IO if they can not get IV access, and since PICC lines pretty much standard with pts needing a central line for TPN post op, I have not seen morphine or hydromorphone given by the IM route in a very long time.

I don't think I've even seen hydromorphone or morphine given IM in my short career. Usually if they don't have an IV for it be be given in, we do it SC.

[NickiLaughs, ADN, BSN, RN]

Because I'm all thumbs and don't have a delicate hand, there's no way I'd be able to push 1 cc over 1-2 minutes. With 10 cc syringe I can much more easily push 1-2 cc every 15 to 20 seconds watching the clock to get it in a better time frame and avoid all those nasty side effects from pushing to fast. It's more for me to accurately push, I know there are others who have more graceful touches, but I just do what works for me and for patient safety.

Obviously this doesn't apply to code medications or adenosine which were meant to be given as quickly as possible.

[Mr. Murse]

Unless you're in an emergency situation or giving one of the few drugs that require very quick administration, "slamming" is a stupid way to push meds. Of course, many meds won't necessarily hurt the patient if given quickly (although many will), but then you have the IV site to consider as well, among other things.

Now, in regards to whether you should always time out each push according to pharmacy orders......well......if you were my new trainee I would say sure. Watch the clock. Be a good little nursling. But once you've been in it a while you will learn to discern the timing of pushes based on the medication, the patient, the site, etc.

[Mr. Murse]

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.

Our pharmacy policy with that is 20mg/min........

[MyCall2Nsg]

Safety First!!

What is the recommended time over which to administer the medication via IV push?

That's the question I ask myself first and if I don't have the answer I use the resources available to find it.

Think of the patient and safety when you have any medication to administer!!

Best Safe Practice

[Flyboy17]

We call it the cath lab push. We will fast push almost every med except Protamine and Calcium/Potassium. Most drugs in a good INT can be pushed fast into the IV pump tubing and allowed to fluch in slowly. The real question should be how quickly do you flush you meds.

[NP2BeNY]

I'm aware of the manufacturer recommendations for these medications, and we have a great many drug resources available to us at work. (Our eMAR also notes recommended administration times), but my point was not if people knew the recommendations, but if they truly gave it that way every time.

As others have said, most meds come in a variety of strengths and packaging for a variety of uses.

[NP2BeNY]

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.

I've heard of patient's c/o burning but it seems to occur more often in those w/o running NS.

[RN_armywife]

I give IV dilaudid several times a shift everyday and will tell you even if I have given 0.8mg to the same patient every 2 hours like clock work, I dilute my dilaudid with atleast 3x the amount of NS and push over atleast one minute and then flush with 10ccs NS for another minute and a half. This is using the port closest to my patient as well and I have made it a habit to stop my fluids and clamp off my main port anytime I am pushing anything because I have a little paranoia that my medication will back flow up.into my primary tube and not into my patient. Anyways I have seen with my own eyes a colleague push a narcotic too quickly and had to call a code within seconds because the patient stopped breathing.

Always push slow...makes for a good shift!!!

[seanynjboy, BSN]

I'm sorry but I have to say this..that person you work with is not safe. Let us know if she decides to "SLAM" a patient with Lasix IV. Push slow on most things and when in doubt call pharmacy. They are your most valuable resource for anything medication related. Do not trust the practice of other people in a lot of cases. "Well, she told me to do it this way because that is what she does" will not hold up in court.

Sorry to be brash, but it's your license...