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.
Nurse piggybacks heparin or tridil etc at 5 mls an hour. Depending on the distance of the port to the site, it could TAKE up to an hour (or 2!!) to even reach the pt!
Nurse piggybacks heparin or tridil etc at 5 mls an hour. Depending on the distance of the port to the site, it could TAKE up to an hour (or 2!!) to even reach the pt!
See that one LOTS!
That's totally bad practise. Both those medications should be on their own pumps.
Specializes in Infusion Nursing, Home Health Infusion.
That is precisely why I wrote some special instructions in our IV push protocol to account for this issue. Just as others have said the priming volume of a T extension is very small about .2 ml. It really depends at what point you are giving the push medication. If you give it at the T extension port or a Y site of the cannula (ie the intima or nextiva) you are essentially giving it at the site and you can give the dose at the recommenced rate.
If you are giving the medication at an injection site on the primary tubing...you need to give your IV medication at the recommenced rate and THEN GIVE THE FLUSH AT THE SAME RATE. If not,you could potentially be giving the dose too quickly causing speed shock and other symptoms.oes in Select enough volume in the flush to make certain the drug is given and not just sitting in the tubing. Primary tubing volumes vary but most are between 10-15 ml from the drip chamber to the distal end.
remember, this also applys at the BEGINNING of the med adm, if you are adm - say .1ml per 15 sec- you havent given the pt anything for the first 30 sec...on a ext with 0.2 fill.....so push the first0.2 of med and time from there.....and time the first 0.2 of flush.....
Specializes in OB, NICU, Nursing Education (academic).
Good thread; I see this and another problem all the time:
I teach RN students in an OB course and clinical. I still see RN's push undiluted phenergan all the time.....drives me crazy (and I have to later point out to students that it is BAD practice). The nurses always tell the students "oh, it's okay, I'm pushing really slow and it's only 25 mg". Sorry, no.
I can tell you from personal experience that one should never underestimate the pain (like you're on fire) that undiluted phenergan can cause.
I alwats dilute narcs/IVPs except for two (zofran, protonix), but definitely make sure i push these slow and follow them with 5-10cc's of NS or more if i am giving a ppush into a running IV with anything but NS...
I'm in the ED so our rules are a bit "loose" for hanging IVF (I don't need an order).
Anyways, I try to hang IVF and hook it up to the pt's IV if I'm pushing meds (I use the IV tubing with the anti-reflux valve, so any medications you push wont go up the tubing towards the IVF bag). I have the IVF dripping at a medium rate while I'm giving IV meds, and I push the med slowly at the port. That way, the med gets flushed in at the exact rate that I want it and there isnt any excess hanging around the extension set. After I'm done, I'll decrease the flow rate to TKO.
I would think that the bigger issue would be someone not flushing slowly after giving a medication through a PICC line. Those hold over 2mls of fluid before getting to the heart. Our extension tubing only holds a very small amount.
BTW does anyone know what happens when you give IV Nexium too fast. I have looked around but can't find the answer and pharmacy always has warnings on Nexium to push over 3-5minutes.
We were taught to dilute in 10mL NS, give the med at the recommended rate, then when flushing, the first five mL at the same rate as the med, then the second 5mL briskly. It's probably overkill, but it does cover the bases, I think.
[i can tell you from personal experience that one should never underestimate the pain (like you're on fire) that undiluted phenergan can cause]
I totally agree. I came in one morning and went to medicate a patient with phenergan and found half of her arm was black from the last person that had pushed phenergan. The patient told me she told the nurse to stop it hurt too bad, and the nurse told her "Phenergan always burns, it is okay."
Our policy is now to dilute any IV phenergan dose in 25cc normal saline and run over 20 minutes.
tridil2000, MSN, RN
657 Posts
Ya, you are right. How about this one...
Nurse piggybacks heparin or tridil etc at 5 mls an hour. Depending on the distance of the port to the site, it could TAKE up to an hour (or 2!!) to even reach the pt!
See that one LOTS!