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.
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 guess that my feeling is that it is an invasive procedure and more liability goes along with that type of procedure. Hence, the instructor should definitely be present for all invasive procedures. I wouldn't let any of my students ever give any injections on their own. That is how I practice and how things are in this state. MA tends to be stricter than most of the other states.
I had a very detail oriented instructor make me do extended education (that was my schools slap on the wrist.........non write up punishment) because of this exact issue. I delivered the medication correctly, but flushed quickly and got nailed for it.
"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).
Depends what setting the vent is on, surely? You can still knock off your patient, as you said better to stand there and give drugs slowly, then flush slowly. With morphine our unit practice is to make it up to 1mg in a ml then give it 1mg at a time, noting the response after each mg.
When I was oriented to the ER I was amazed at the ways different preceptors told me to do things. For instance, one preceptor could take the same 1mg dilaudid and push it, dilute with 10l ns, place in a bag all for very specific reasons. We don't always use pumps and as previously mentioned fluids run without orders all of the time. From those nurses I took their best reasoning and consider my own whenever I give medications to anyone.
That along with not to trust anyone's med advice is the first thing I tell my new nurses, listen to everyone's reasons the do what you think is right based on the situation(barring medical side effects of course).
Of course you are right with regards to the quick flush, the med is usually just sitting in the extension tube unless accompanying fluids are running; therefore a quick whoosh of medication is delivered. That's why I like accompanying fluids, slow and steady and it's in.
Here's a question, can anyone tell me the rationale for being able to push rocephin(1gm/10ml) over four minutes, but if it's hung as an infusion in 50ml it is tagged to run at 15 minutes? No one can come up with a reason at our place.
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).
LOL, sometimes I get impatient when I have a non-vented patient and I will stick certain meds on the bard pump because I'm too hyper to stand there and push them forever...
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.
In our program we started giving IVP meds third semester, and my instructor only needs to be there with me if it's a scheduled substance. I push Lasix, Zofran, Protonix, solumedrol, etc. frequently with only the nurse I'm assigned to in the room or nearby (if in ICU).
In the program I attend, I was giving IV pushes and injections by myself about half way through my first med/surg clinical. The instructor would assist in getting the med out, watch me prepare it or draw it up, and then quiz me on administration technique and timing. As far as I know, this was allowed at all of the clinical sites for our school. Some students didn't grasp the concepts as quickly as others (or the instructor was not comfortable letting that person administer the meds without supervision), and some students still had an instructor or staff RN help with IV pushes at the end of the semester.
when i was oriented to the er i was amazed at the ways different preceptors told me to do things. for instance, one preceptor could take the same 1mg dilaudid and push it, dilute with 10l ns, place in a bag all for very specific reasons. we don't always use pumps and as previously mentioned fluids run without orders all of the time. from those nurses i took their best reasoning and consider my own whenever i give medications to anyone.
:wink2: hi,
i am surprised to read that you don't use a pump with dilantin. dilantin should always be on a pump. what is your standard protocol in your facility?
here's a question, can anyone tell me the rationale for being able to push rocephin(1gm/10ml) over four minutes, but if it's hung as an infusion in 50ml it is tagged to run at 15 minutes? no one can come up with a reason at our place.
i am also surprised to read that you run an atb (any atb) over 15 min. 50 ml of any atb should be run over 30 min. and not 15 min. i am wondering about the policies in your facility? do not sound very strict to me. and, maybe it is a new thing but i never knew you could push rocephin or any atb.
i don't give iv meds wrong ,, i've taught new nurses the correct way to give iv meds !! you are right it is very importan to do it the right way, you are giving them drugs that could kill them ..
In the program I attend, I was giving IV pushes and injections by myself about half way through my first med/surg clinical. The instructor would assist in getting the med out, watch me prepare it or draw it up, and then quiz me on administration technique and timing. As far as I know, this was allowed at all of the clinical sites for our school. Some students didn't grasp the concepts as quickly as others (or the instructor was not comfortable letting that person administer the meds without supervision), and some students still had an instructor or staff RN help with IV pushes at the end of the semester.
As always, an instructor is liable for any wrong doing the student does. They are responsible for that student. I feel it is poor practice for a nursing instructor to not be present. That is how I practice and how many practice at the schools in my state (I have taught at 3).
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Lstcats
102 Posts
Oh, yes I get it. yes, you have to disconnect something and reconnect.