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.
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.
our standard for rocephin is over fifteen minutes as well. i'll have to remember to ask the pharmacist why that is.
Actually our pharmacist prefers the iv push rocephin and doesn't like it in a bag, however our facility policy is push over 4 minutes and in a bag over 15 minutes.
As far as meds I always try to use a pump for antibiotics-I want to know it will run as directed, as for dilantin and other specific drugs they should always be on a pump. Unfortunately, we don't always have pumps as they travel to the floor so you never know what you will find hanging free.
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).
Yes, because when you're working in ICU, covering 8-12 critically ill patients, it's vital to take every little shortcut you possibly can.
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).
Absolutely. However, it's a generalization to state that anyone who allows her(/his) students to administer any type of injection without being present is a "poor instructor." My instructor has been a nurse for well over 40 years, still works at the bedside, and is well respected and trusted by the staff on this unit. She has been a nursing instructor for decades, and would never do anything to jeopardize a patient's safety (or her license, for that matter).
Back to the original topic, I have seen a few nurses do this incorrectly, but the majority that I have seen flush slowly.
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).
That's not the way it works in Texas. We have a maximum 10:1 student:instructor ratio in clinicals, and believe you me, with how low instructors are paid nearly every program is at that limit.
Now, our instructors are good, but they can't be at 10 places at once, often on multiple floors. We aren't under the instructor's license, as is popular misconception. We learn under a provisional student license the state grants to nursing schools.
The instructors are responsible to make sure we are competent in our decisions and skills, but once we are competent, we also gain a certain amount of independence. This is necessary, because were it otherwise, despite the fact I graduate in exactly four months there'd be multiple days I wouldn't get to perform even basic tasks were instructor supervision required for skills at all times.
Our school's contract with the locals hospitals operates under the assumption that the nurses actually responsible for our patients are our preceptors, and should be capable and competent to perform supervisory roles as needed to ensure the best for the patients.
The point I'm trying to make is that instructors are not liable for students' mistakes provided the instructor has already verified competency and proficiency in a task or role. My instructor has seen me place a half-dozen IVs in clinicals, and knows I've placed hundreds with my ER tech background. It is not her fault if I am starting an IV on a patient with the supervision of my preceptor nurse and I stupidly start an a-line by accident as she has validated my competency before granting me such independence (being "checked off").
NJ is also 10:1 and nursing students are working provisionally and must have nursing insurance when they visit hospitals. Additionally, they must take all of the charting and instructional paperwork that a new hire receives at any facility they train.
I see this more than enough! I was taught to flush slowly after the med being pushed because just like u said u are giving the pt a bolus if u flush fast. I always flush slow, it cracks me up when the pt's say" why u pushing that so slow all the other nurses push it fast" Mostly when Im pushing Morphine or Dilaudid??
I used to always like to dilute my Morphine in a 1cc/1mg 0.9% mix. The facility I'm at now has Morphine in this weird little prefilled tubes that need a special "syringe" to administer it. It is 10mg in 1cc. Wayyy concentrated. So, I ran my IV fluids fast and give it slow as the best way I can dilute it. I'll push 1-5 at a time for a max of 20 depending on the patient and their pain level with relation to RR and BP.
It's a PACU so I'm at the bedside watching the whole time. I lol'ed at the person who posted about pushing 1mg of Morphine at a time and waiting for the result. The least I'll ever give someone is 2-4 mg at a time. Plus the fact that I have to keep someone 20 minutes after the last dose is incentive to "make it count and make sure their pain is gone"
Phenergan (and others) I will ALWAYS dilute and slow push after confirming that the catheter is in the vein. =( Thinking about that lady who lost her arm...
I lol'ed at the person who posted about pushing 1mg of Morphine at a time and waiting for the result. The least I'll ever give someone is 2-4 mg at a time. Plus the fact that I have to keep someone 20 minutes after the last dose is incentive to "make it count and make sure their pain is gone"
That would be me that posted about 1mg at a time...I know it sounds slow. However this is with very unstable patients in ICU, and believe me I'm not timid about giving appropriate types and quantities of analgesia.
Most of our patients are on continual infusions so we don't give too many boluses.
Perhaps I should say that in November I had to give evidence in the coroners court after being involved in a med error so am extremely vigilant about the response a pt has to any drug I give.
Yes, because when you're working in ICU, covering 8-12 critically ill patients, it's vital to take every little shortcut you possibly can.
I hope this was a typo and you didn't mean that an ICU nurse takes care of 8-12 patients. Not sure what you meant because 2 or maybe 3 is the max anywhere you go.
I hope this was a typo and you didn't mean that an ICU nurse takes care of 8-12 patients. Not sure what you meant because 2 or maybe 3 is the max anywhere you go.
I thought the op was being sarcastic, not literal.
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mama_d, BSN, RN
1,187 Posts
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.
our standard for rocephin is over fifteen minutes as well. i'll have to remember to ask the pharmacist why that is.