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.
Specializes in Community Health, Med-Surg, Home Health.
I have seen so many wild ways that IV medications were hung that I am still not sure if I am really doing the correct thing. I work in a clinic, so, I only see what is happening when I do med-surg per diem, but it is scary. I can think of at least three ways I have seen potassium hung and each one has scared me to no end. I try to remember what staff ed told me, and what frustrated me is when I asked if I can meet with someone who can review the steps with me, they always seemed too busy. What I did was watch what steps a nurse made that was close to what I witnessed in staff ed, and from there, that is what I basically did, and now, I feel safe with what I do but, boy...I have seen weird stuff...
I am kind of lol at this thread with no malice intended. I guess I have been a med/surg nurse too long and have so many patients who get really ticked off when you administer an IV pain med slowly. They want it NOW!
Without going into to details of what happens if you administer this drug incorrectly: Someone had to have their arm amputated from it.
Antibiotics/drips/whatever.... Your start time of the drug is when the drug is actually going in to the patient's venous circulation. Not when you hang it. My preceptor looked at me like "***" when I ran my Vanco wide open when I hung it. I promptly slowed it to my rate I wanted once I ran it through the 1,000,000 miles of IV tubing. Then I noted the time. They just hang the drug and it takes about 5-10 minutes (depending on the rate) for it to travel to the patient.
Our policy is now to dilute any IV phenergan dose in 25cc normal saline and run over 20 minutes.
I agree, phenergan is nasty! No defense for not diluting properly - that's just asking to lose your license!
I like the IVPB phenergan route - it might keep some of our seekers away. They do get mad, like someone else said, when you try to push at the far port or dilute. They like the quick hit! Maybe I can get my pharmacy to start diluting phenergan like that....
Antibiotics/drips/whatever.... Your start time of the drug is when the drug is actually going in to the patient's venous circulation. Not when you hang it. My preceptor looked at me like "***" when I ran my Vanco wide open when I hung it. I promptly slowed it to my rate I wanted once I ran it through the 1,000,000 miles of IV tubing. Then I noted the time. They just hang the drug and it takes about 5-10 minutes (depending on the rate) for it to travel to the patient.
Can I just ask--what difference does it make? Whether it took 5-10 minutes or not to get to the pt, and whether the start time was then exactly correct or not? I'm not sure why you expend any time or energy on worrying about when exactly when the abx hit the pt's venous circulation. Why does it matter on a routine drug in a non-ICU situation?
Can I just ask--what difference does it make? Whether it took 5-10 minutes or not to get to the pt, and whether the start time was then exactly correct or not? I'm not sure why you expend any time or energy on worrying about when exactly when the abx hit the pt's venous circulation. Why does it matter on a routine drug in a non-ICU situation?
If it's a first dose, it matters to me. I want to be present to observe the patient for a few minutes just in case of a reaction. I don't want to hang the med, then go on my merry way, getting caught up in other things, only to come back much later and notice the problem then. If they've been getting the med for a day or two, I don't worry so much about it.
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).
The nurse does have a point. I used to work in the ICU and it is a different standard because the pt. is on a vent. You still should be careful and not "shove" it in but don't need to push say over 2 min. like you would w/ a nonvented pt. But, more of a concern that I have is WHY was your nursing instructor not in the room w/ you? And, why in a nursing program would you be pushing IV meds anyway. It is not allowed in the ADN program where I teach for any nursing student at any time to push even Lasix. I do it and demonstrate it to them. As a student, you should never give any injections especially IV on your own. What a poor instructor you must have had but sounds like you were a really good student.
I hate when an IVP is to be given and there's no port available in a running IV. It seems like disconnecting the tubing, pushing the med, and reconnecting the tubing is an infection risk.
If it's a first dose, it matters to me. I want to be present to observe the patient for a few minutes just in case of a reaction. I don't want to hang the med, then go on my merry way, getting caught up in other things, only to come back much later and notice the problem then. If they've been getting the med for a day or two, I don't worry so much about it.
Yeah, I get that and I completely agree with you; but outside of first dose, extremely unstable pt, or something like blood, I don't see what the big deal is. I'm guessing the preceptor's look was more of a "what difference does it make, this is this guy's 5th dose of vanco" look, not a "I don't understand the mechanics of priming a line and noting the exact time" type of look. KWIM?
I could totally be mistaken, though. It has happened. Occasionally.
I do completely agree with Andrew that it is good practice to observe the pt for reaction and to know when the med hits the body; I just don't see what it matters, whether I document the time it is hung or the time it actually enters the body. I do try to hang out, though; hang the med and then offer to help brush teeth, or grab a set of vitals, or something.
I hate when an IVP is to be given and there's no port available in a running IV. It seems like disconnecting the tubing, pushing the med, and reconnecting the tubing is an infection risk.
Hi,
I am so surprised that you use tubing that doesn't have either a Y connection or any other type of port. No, you shouldn't be disconnecting the IV to push a med. Don't you have a needless system? In todays technologically advanced systems I am surprised that you don't have up to date equipment.
The nurse does have a point. I used to work in the ICU and it is a different standard because the pt. is on a vent. You still should be careful and not "shove" it in but don't need to push say over 2 min. like you would w/ a nonvented pt. But, more of a concern that I have is WHY was your nursing instructor not in the room w/ you? And, why in a nursing program would you be pushing IV meds anyway. It is not allowed in the ADN program where I teach for any nursing student at any time to push even Lasix. I do it and demonstrate it to them. As a student, you should never give any injections especially IV on your own. What a poor instructor you must have had but sounds like you were a really good student.
Just because your school doesn't do it does not mean the instructor is 'poor'.:icon_roll. I most certainly did injections on my own. I have also done IVP (with an instructor present), but nevertheless, we did them.
I am so surprised that you use tubing that doesn't have either a Y connection or any other type of port. No, you shouldn't be disconnecting the IV to push a med. Don't you have a needless system? In todays technologically advanced systems I am surprised that you don't have up to date equipment.
Of course we do. But sometimes all the ports are taken and something has to be disconnected.
pagandeva2000, LPN
7,984 Posts
I have seen so many wild ways that IV medications were hung that I am still not sure if I am really doing the correct thing. I work in a clinic, so, I only see what is happening when I do med-surg per diem, but it is scary. I can think of at least three ways I have seen potassium hung and each one has scared me to no end. I try to remember what staff ed told me, and what frustrated me is when I asked if I can meet with someone who can review the steps with me, they always seemed too busy. What I did was watch what steps a nurse made that was close to what I witnessed in staff ed, and from there, that is what I basically did, and now, I feel safe with what I do but, boy...I have seen weird stuff...