IV pushes

Nurses Medications

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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!

Specializes in Acute Care - Adult, Med Surg, Neuro.

I have read stories of patients going deaf from too fast pushes (Lasix if I remember). Medications can be dangerous if given too fast.

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

Yes! It's great.

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Specializes in MICU, SICU, CICU.
Our pharmacy policy with that is 20mg/min........

I have have worked in hospitals where that is the the policy, and even Lexicomp says it is okay to do so, but I just can't do it. I have seen people become hypotensive and pass out when furosemide is given at that rate. Every patient is different. 10 mg a minute is how I was taught, and that is what I am comfortable with doing.

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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:

I think it is mini infuser they are talking about. It just pushes med slowly

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Specializes in Neonatal Nurse Practitioner.
I think it is mini infuser they are talking about. It just pushes med slowly

Nope. It's the actual pump. The B port is in the cartridge allowing you to screw the syringe right at the pump, and it can infuse it for you.

http://www.google.com/imgres?imgurl=http://www.hospira.com/Images/248x248_PS_Plum_81-90163_1.jpg&imgrefurl=http://www.hospira.com/en/products_and_services/infusion_pumps/plum/&h=248&w=248&tbnid=J_29B-RGatsVZM:&zoom=1&docid=rflEtwZCHfrz9M&hl=en&ei=03-MVLqgDM3coATcyIL4Dw&tbm=isch&client=safari&ved=0CB0QMygAMAA

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Specializes in OR/PACU/med surg/LTC.

Yup that is what we have as well. Only thing is that we cannot use the prefilled normal saline flushes as it is not compatible to fit onto the B port.

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Specializes in Critical Care.

I typically use a "carrier" line for those that need frequent IV pushes, which is often most ICU patients. We usually run a line at 25ml/hr and use the distal and mid ports on the line to run pushes in appropriately. When using the port 6mls from the tip that will run that 6mls in over about 15 minutes, about 7 minutes using a full 3 mls from the distal port, or for one that can go in relatively faster we'll use the distal port with a smaller volume and push it up to the tip with with a couple mls of flush.

What a patient can tolerate and what's appropriate vary by patient, although the recommended rates are a good start. Our policy is to run dilaudid in at max rate of 0.4 mg/minute, for instance. But I've also had patients on a continuous dilaudid infusion that's going at more than 200 mg/hr and still requiring boluses of up to 50 mg q 15 minutes, obviously the effect of x amount of medication over x amount of time affects them differently, so standardized rules are good so long as one of those rules is to remember most patients don't fit that description.

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Specializes in Critical Care/Vascular Access.
But I've also had patients on a continuous dilaudid infusion that's going at more than 200 mg/hr and still requiring boluses of up to 50 mg q 15 minutes.

What?!?! A patient getting 200 MILLIGRAMS of dilaudid in an hour? or up to 400mg if you gave the boluses? are you sure you've got your units right? the most I've ever seen is a patient on a high dose PCA getting 1mg of dilaudid every 8 minutes, totaling around 7.5mg an hour, which was quite an incredible amount of dilaudid and very few surgeons I've worked with (surgicalICU or GI surgical) would even push it that far. if you had said 10-20mg/hr, I could almost believe it......but 400?!?

I'm wondering if maybe you had dilaudid that was well diluted and you were maybe running it at 200mL/hr instead of mg/hr? if you did in fact mean 200mg/hr please tell me a little more about this patient that would even require that much dilaudid, much less survive it.

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Specializes in Critical Care.
What?!?! A patient getting 200 MILLIGRAMS of dilaudid in an hour? or up to 400mg if you gave the boluses? are you sure you've got your units right? the most I've ever seen is a patient on a high dose PCA getting 1mg of dilaudid every 8 minutes, totaling around 7.5mg an hour, which was quite an incredible amount of dilaudid and very few surgeons I've worked with (surgicalICU or GI surgical) would even push it that far. if you had said 10-20mg/hr, I could almost believe it......but 400?!?

I'm wondering if maybe you had dilaudid that was well diluted and you were maybe running it at 200mL/hr instead of mg/hr? if you did in fact mean 200mg/hr please tell me a little more about this patient that would even require that much dilaudid, much less survive it.

Yes, that's 400 (four hundred) milligrams (not mls). The patient had developed a high tolerance of opiates due to chronic, high dose pain medication use over a long period of time, the patient then developed a metastasized abdominal cancer. And yes, I'm talking about the same dilaudid that you would typically give in 0.2 to 1 mg doses IV. We were also using IV ketamine at double the normal max dose to potentiate the dilaudid, as well as precedex, high dose steroids, etc.

Even at those amounts however we still weren't adequately controlling the patient's pain and ended up having to do palliative sedation using versed and propofol.

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Specializes in Adult Internal Medicine.
Yes, that's 400 (four hundred) milligrams (not mls). The patient had developed a high tolerance of opiates due to chronic, high dose pain medication use over a long period of time, the patient then developed a metastasized abdominal cancer. And yes, I'm talking about the same dilaudid that you would typically give in 0.2 to 1 mg doses IV. We were also using IV ketamine at double the normal max dose to potentiate the dilaudid, as well as precedex, high dose steroids, etc.

Even at those amounts however we still weren't adequately controlling the patient's pain and ended up having to do palliative sedation using versed and propofol.

Who is prescribing that. That is way over the dose that has any efficacy.

Sent from my iPhone.

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Specializes in Critical Care.
Who is prescribing that. That is way over the dose that has any efficacy.

Sent from my iPhone.

It was being managed by our palliative care doctors in conjunction with the palliative care team at the regional major teaching hospital.

As far as I know there is no established dose at which receptor saturation occurs, the only thing we know is that it is highly variable. One way to tell if you've reached maximum efficacy is when additional amounts do not produce any additional effects, and the boluses were still clearly producing an effect both subjectively and objectively.

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Specializes in Adult Internal Medicine.

The extant research demonstrates that doses over 180mg of oral morphine have no increased analgesic effect, only increased ADR.

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