IVP vs Drip

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Hello!!

had a question regarding medication administration. If yo have an order for a medication and it just says to be given IV, can you as the nurse choose to either give it as a push or a drip? Of course I know some meds must be an infusion, like antibiotics. However, what about meds like morphine, Benadryl, reglan, etc. Could you put them in a 50cc bag and let them run in over ten minutes instead of standing in the room and doing a two minute push? I guess I am just thinking of those crazy times when you want to medicate a patient for pain and don't want to rush, can you put their morphine and zofran in a bag and let it infuse? Just wondering.

Specializes in POCU/PACU, Hospice.

In the PACU, unless the patient has a PCA we push all the narcotics. Between them not being fully stable (and having to switch dosages and meds around a bit) and us being right at the bedside anyway, its not really a problem.

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What requires an order in general is a regulatory issue and in that context there is no difference between and IV push and intermittent infusion, those are different terms for the same thing. Part of what I do is regulatory compliance, and no regulatory body designates a point at which an IVP becomes a "intermittent infusion", they don't differentiate between the two. Whether an IV medication is put into the proximal port to infuse or the distal port to infuse makes no difference in what the order has to say, and putting into a bag is functionally no different than using a more distal port.

From a regulatory standpoint, intermittent infusion orders do not actually require a concentration, that can be, and usually is, up to those interpreting the order, either pharmacy or nursing, to determine based on facility approved resources, which can be the manufacturers IFU, an approved drug guide, etc.

Don't go confusing the issue with facts.

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What requires an order in general is a regulatory issue and in that context there is no difference between and IV push and intermittent infusion, those are different terms for the same thing. Part of what I do is regulatory compliance, and no regulatory body designates a point at which an IVP becomes a "intermittent infusion", they don't differentiate between the two. Whether an IV medication is put into the proximal port to infuse or the distal port to infuse makes no difference in what the order has to say, and putting into a bag is functionally no different than using a more distal port.

From a regulatory standpoint, intermittent infusion orders do not actually require a concentration, that can be, and usually is, up to those interpreting the order, either pharmacy or nursing, to determine based on facility approved resources, which can be the manufacturers IFU, an approved drug guide, etc.

Since I don't deal with regulatory issues, I'm speaking from experience as an infusion RN as well as policy at every facility I have worked at. While there may or may not be actual regulations by some outside body on this issue, there are individual facility policies as well as safe medication practices that the OP should probably be referring to.

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Our ED docs order meds ALL THE TIME (as in, every single time they order an infusion, aside from potassium for some reason, which automatically enters that it's 10mEq/hr) with no infusion rate. Not a single order says how long to infuse the meds over. But, you can easily look up how long meds infuse over or call pharmacy if you aren't sure what rate to infuse at. That said, I hang certain meds instead of pushing. Not too often, but I do.

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There is a difference between an IV push and an infusion. They are two different things, requiring two different types of orders.

Agree with this poster.

If it's ordered intravenous, it's an IVP.

If it's ordered Infusion, it's an Infusion

Cut and dry, if you deviate you are not following orders or the Medication rights.

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Agree with this poster.

If it's ordered intravenous, it's an IVP.

If it's ordered Infusion, it's an Infusion

Cut and dry, if you deviate you are not following orders or the Medication rights.

So if I get an order for "Potassium, 20 meq iv", are you suggesting I push it?

I work in an ER, and that is what my order will look like.

When I give it as a drip, how am I not following an order, and which of the 5 rights am I missing?

And when I get an order for "Compazine 10 mg IV, I will put it in a small bag and run it over at least 10 minutes. As would many nurses who have seen a compazine reaction. And I will be giving the right:

  1. pt
  2. med
  3. dose
  4. route
  5. time

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Usually it's ordered as an intravenous infusion vs just intravenous

My thinking that it is part of the right route, may not be but not following the order if it's ordered that way idk

It also may be against facility policy to mix yoursef, but I dont know that

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Usually it's ordered as an intravenous infusion vs just intravenous

My thinking that it is part of the right route, may not be but not following the order if it's ordered that way idk

It also may be against facility policy to mix yoursef, but I dont know that

In my experience, docs know the meds, but they know nothing about infusion rates, etc.

They trust that nsg judgement and hospital policy will manage that, and the pt will get the med intended.

I am talking about ER. There may be facilities in which a doc writes: "Potassium 20 meq in 100 ml ns to be infused over one hour." Not in any of the ERs in which I ave worked.

As far as the right route: The route is IV. Rate of administration, concentration, choice of diluent, etc do not alter the route. IVP and IVPB, IV infusion, are all IV. If it is given as an infusion order and pushed, then the nurse is not following the order. If the order is simple "IV", then as long as it is given IV, the nurse is following the route ordered.

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In my experience, docs know the meds, but they know nothing about infusion rates, etc.

They trust that nsg judgement and hospital policy will manage that, and the pt will get the med intended.

I am talking about ER. There may be facilities in which a doc writes: "Potassium 20 meq in 100 ml ns to be infused over one hour." Not in any of the ERs in which I ave worked.

As far as the right route: The route is IV. Rate of administration, concentration, choice of diluent, etc do not alter the route. IVP and IVPB, IV infusion, are all IV. If it is given as an infusion order and pushed, then the nurse is not following the order. If the order is simple "IV", then as long as it is given IV, the nurse is following the route ordered.

Our orders state intravenous infusion vs just intravenous .

The doctors don't order the rate etc. The pharmacy and protocols do that

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Our orders have rates, dilutent/volume, and push/piggyback/infusion. Usually if we want something different and it is reasonable, that's fine as long as the order is changed. Problem is if the way we want to do it is outside of "normal" making the order read right is too much of a pita to bother with. By the time we figure it out and set things up, we could have completed the original order (which is usually part of a "set" anywho)

BSN GCU 2014.

Sent from my iPhone using allnurses

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Lets say you have a 1 ml push dose, you want to give over 2 minutes. Leaving it undiluted would have you administering it 120/ml per second. A small bump would administer a significant part of the med, and then of course with an extension, you have priming volume to deal with.

So, most of us dilute in a 10 cc syringe to push slowly. If you have the right kind of pump, you can use the pump to administer the syringe.

Am I changing the order if I dilute in a syringe and use the pump? Does it matter how big the syringe is?

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I know most NPAs cover flushing IV lines, so I would assume (bad thing, I know) that diluting 1mL IVP into a 10mL flush is well within scope of practice. However, fluids require a providers order, so without the providers consent to dilute that 1mL (let's say it is Dilaudid) into a 50mL bag of NS, I would be wary that I would be changing an order and "practicing without a license".

IV orders need to have the med/fluid requested, the dosage/amount, and the rate or amount of time to infuse. If the MD doesn't know this, then the pharmacy can add what is required (let's say the MD ordered 1g Vanco IV, nothing else). When the pharmacist fills the request they can put in the dosage/VTBI (volume to be infused) and the rate (or amount of time over which to infuse). What the provider originally wrote as 1g Vanco IV, now becomes 1g Vanco/250mL NS infuse over 90 min.

On the other hand, if I got an order for 1L 0.45% NS with 10mEq K+ without any other information, I would NEVER use my "nursing judgement" to figure out the rate and duration of the infusion!! This patient could have so many things going on that if I infuse it too fast, I could stop their heart, put them in fluid overload, etc. I need to clarify the order with the provider and see if they want it running wide open, if they want it over 1 or 2 hours, or if they want it on a pump for a longer duration of time. If there was an adverse event with this patient and I had used my "nursing judgement" to just let it run, I could possibly be pulled into court. I want to cover my rear first and foremost. It never hurts to ask the provider if they are okay with you adding the med to a 50mL bag of NS. If they say yes, GREAT, if they say no...you could have just stopped a potential lawsuit or board sanctions for practicing medicine without a license.

Just my .02.

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