Many RN's administer IV meds wrong.

[Guest219794]

PT has a heploc. Standard IV and extension. The nurse flushes, then administers the med, lets say 1 mg dilaudid in 1 ml very slowly. We all know Dilaudid given too quickly can be problematic. (as can many drugs) The nurse than flushes the line briskly to maintain a good line.

What has actually happened here is that the nurse gave the dilaudid very slowly to the extension. That extension holds 1.5 ml (or whatever) Then by flushing it it, the nurse delivers a rapid bolus to the pt.

Spending two minutes delivering a drug to pvc tubing, only to rapidly deliver it to the pt is nuts.

I see this frequently, and wonder if others see the same.

hherrn

[FireStarterRN, BSN, RN]

You have a point there.

[1styearsucks]

Wow you are so right!! What a simply thing I have never thought of. I do this all the time. So, the point here is to flush it slowly..right?

[blondy2061h, MSN, RN]

Yep, I see that all the time too, and it makes me sigh.

[GrumpyRN63, ADN, RN]

Our extention tubing diameter is very tiny, probably fills in .2 -.3 cc's that being said, we all usually dilute our meds minimally to 10 cc NS, so the pt has really gotten all of it before the final NS flush. I think this is the rule rather than the exception, ie: valium where you can't dilute and push slowly.

[FlyingScot, RN]

But it depends on the fill volume of the extension set. Most of the ones I've used have a fill volume of 0.2-0.5 mls. If your set has a fill volume larger than that (the most I've seen is about 1.7mls) then you are correct. It pays to know your equipment doesn't it.:cheers:

[Mommy_of_3_in_AL..RN]

I am a new nurse, and always wondered this. I was always so horrified to push a med to fast and cause problems, then when i saw nurses flushing quickly, i would think "well what did you just stand there 2 mins for, if you are just going to jam it in." Glad i am not the only one thinking that.

That being said, when i push a drug that is to be given slowly, i push slow, flush slow, then go back and flush again to make sure the line is clear.

Another thing that blew my mind..i was in ICU clinicals, and mind you, ALWAYS had it drilled into my head to push ativan and morphine slowly. I had a vented patient that was receiving both drugs, and pretty regular intervals, and i was standing there pushing slowly, and the nurse i was with came in and said "just push it"...i just looked at her like she was crazy, and she said "baby, she is on a vent..you cant kill her with a little morphine"....made sense to me!!! So now, i feel bettter pushing meds a little quicker on a vented patient (but i still dont just shove them in).

[tookewlandy]

I am a new RN to, But when I was in school( a few months ago lol) We were taught hat when you give an IVP med, You time the follow flush as well, so if you give lasix over at least 2 min you should flush at least 2 min after you give the med, Another intructor said that you dont have to flush the exact time the med was to be given over, but you should push in the first mL slow maybe over 30sec-min then flush regular to account for the med still in the tubing. That being said I never see any of the other nurses do that, I still do though.

[Guest219794]

What is key is to know the volume of the tubing. even more key if you are putting the med into a clamped iv line.

This is surprisingly common. I just checked a nursing reference, and the technique described did not account for tubing volume.

Why is this

hherrn

[Valerie Salva, BSN, RN]

I flush a tiny bit, then wait a little, flush a tiny bit more, wait a little more and so on.

[miko014]

Which is why dilution is important. I ALWAYS dilute stuff I push through a HW/HL/SW/SL (whatever you call it at your particular institutuion).

The lines you should really worry about are the ones with larger priming volumes such as central lines, PICCs, Midlines, and IPs that are HL'd. Even if you dilute those, you're still going to have a good amount of med left in them when you start the flush.

[EMTandNurse2B]

This also drives me crazy! Also, pinching the line closed (or turning it off) when administering meds IVP into a running line (NS, or other compatable fluid). You do the same thing here when you pinch the line off, even if you use the lowest port. I puposefully open the line wide, and slowly given the med so that it flushes in slowly as I push it. I then leave it open for 1-2 minutes to flush it all in, and then put it back to the original rate.