Med-Surg IV Meds

[Gyh]

I am starting a Med-Surg job soon and I have never worked in the hospital. Nurses who work Med-Surg what are the common IV push and IV medications? I want to review most common IV meds so that it's not too overwhelming when I start the job.

[Hoshio, RN]

Honestly in my experience, there isn't a standard set of IV medications. The IV medications you'll be giving depend a lot on the patient population you're working with and their medical issues. Most IV push medications I've used are lasix, narcotics, protonix, sometimes even I've had antibiotics IVP. IVs on a pump have been anything from certain antibiotics, heparin, blood, fluid. I would really encourage just having a basic understanding of pharmacology going into your job, and while working lookup and become familiar with the medications you'll be working with on the floor. I think it's much easier to grasp medications by working with them.

Biggest tips to remember for IVP medications is knowing how long to push them over. For hung medications it's important to know if the fluid & the medication you're mixing with are compatible with one another, and or if you should run a medication as a primary only or with a secondary.

[NightNerd, MSN, RN]

In addition to the above, methylprednisolone, dexamethasone, etc. are some that I've come across recently. Like Hoshio said, it's hard to anticipate all the possible IV meds you may push. Know your resources and always look up meds you're unfamiliar with before giving them. Look up how fast or slow to push, compatibility with IVF, side effects, and how irritating they are to vessels should the IV infiltrate.

Also, if you're going to a med-surg floor, there are likely some meds or doses you aren't allowed to give per policy. There should be a resource where you can see whether a certain med or dose can be given on your floor. I learned the hard way soon after going from palliative nursing to a med-surg unit that I couldn't give the same doses of pain medication I was used to. ? (The patient was fine, but I hadn't checked our policy, and the dosage I gave of this narcotic was such that the patient was supposed to be monitored at a higher level of care due to risk of respiratory depression.) Usually providers have a sense of what meds can be given where, but if you're unsure, better to be safe and double check before giving the med.

[mmc51264, BSN, MSN, RN]

Antibiotics. All day every day.

[Gyh]

On 8/3/2020 at 2:33 AM, Hoshio said:

Honestly in my experience, there isn't a standard set of IV medications. The IV medications you'll be giving depend a lot on the patient population you're working with and their medical issues. Most IV push medications I've used are lasix, narcotics, protonix, sometimes even I've had antibiotics IVP. IVs on a pump have been anything from certain antibiotics, heparin, blood, fluid. I would really encourage just having a basic understanding of pharmacology going into your job, and while working lookup and become familiar with the medications you'll be working with on the floor. I think it's much easier to grasp medications by working with them.

Biggest tips to remember for IVP medications is knowing how long to push them over. For hung medications it's important to know if the fluid & the medication you're mixing with are compatible with one another, and or if you should run a medication as a primary only or with a secondary.

Did you have to infusions of insulin? Insulin titrations?

[Gyh]

11 hours ago, NightNerd said:

In addition to the above, methylprednisolone, dexamethasone, etc. are some that I've come across recently. Like Hoshio said, it's hard to anticipate all the possible IV meds you may push. Know your resources and always look up meds you're unfamiliar with before giving them. Look up how fast or slow to push, compatibility with IVF, side effects, and how irritating they are to vessels should the IV infiltrate.

Also, if you're going to a med-surg floor, there are likely some meds or doses you aren't allowed to give per policy. There should be a resource where you can see whether a certain med or dose can be given on your floor. I learned the hard way soon after going from palliative nursing to a med-surg unit that I couldn't give the same doses of pain medication I was used to. ? (The patient was fine, but I hadn't checked our policy, and the dosage I gave of this narcotic was such that the patient was supposed to be monitored at a higher level of care due to risk of respiratory depression.) Usually providers have a sense of what meds can be given where, but if you're unsure, better to be safe and double check before giving the med.

Thank you for telling me this! I have 3 years of impatient hospice background so I can see me be comfortable giving large doses of opioids.

[Gyh]

9 hours ago, mmc51264 said:

Antibiotics. All day every day.

LOL I bet! Amy IV medications that needed to be titrated following a protocol in your experience? Any IV push or IV medications that are cardiac related?

[Hoshio, RN]

On 8/3/2020 at 10:55 PM, Gyh said:

Did you have to infusions of insulin? Insulin titrations?

In my setting, which is not an ICU, we do not allow Iv insulin per our policy by nursing. I’ve had some MDs that try to pressure nurses to do it here, but I simply tell them per policy I cannot administer that med, so either we do subq or I tel them they can come up and administer it themselves and stay with the patient to monitor them.

I had one moonlighter tell me after explaining our policy to them “it’s just insulin I don’t get the big deal”. The big deal that this isn’t an ICU, an IV insulin might kill my patient if done incorrectly ?.

On 8/3/2020 at 11:01 PM, Gyh said:

LOL I bet! Amy IV medications that needed to be titrated following a protocol in your experience? Any IV push or IV medications that are cardiac related?

Only different step meds I’ve done are either blood or tpn. Any high risk medication infusion will have a policy. Just lookup, and READ it.

For example, on the unit next to mine I remember a new nurses started a heparin drip on a patient and “looked up” the policy, but doubt she read it because the provider never ordered initial labs prior to initiating the drip which per our policy MUST be done before heparin is hung.

If you’re unsure about a policy, go up your chain of command to make sure you’re doing everything per your facility.

Also, depending on your facility providers may not need to specify rates for medications IV in their order. If you’re running things that don’t exist on a smart pump , always always always - verify the rate is acceptable for that medication with the pharmacist , and have them check your math and do a double check with another nurse. Basic mode is a scary mode on pumps, because the pump will do whatever you plug into it.

[NRSKarenRN, BSN, RN]

Intravenous Medication Administration: What to Know

Quote

Drugs typically given by IV

Some of the drugs more commonly given by this method include:

chemotherapy drugs such as doxorubicin, vincristine, cisplatin, and paclitaxel -- often restricted to Oncology unit

antibiotics such as vancomycin, meropenem, and gentamicin

Cephalosporins such as cefepime (maxipime), cefazolin (Ancef), ceftriaxone (Rocephin)

Fluoroquinolones such as moxifloxacin (Avelox), ciprofloxacin (Cipro) and levofloxacin (Levaquin)

Penicillin such as piperacillin/tazobactam (Zosyn)

antifungal drugs such as micafungin and amphotericin

pain medications such as toradol, hydromorphone, morphine and dilaudid

drugs for low blood pressure such as dopamine, epinephrine, norepinephrine, and dobutamine

immunoglobulin medications (IVIG)

Heparin

https://www.healthline.com/health/intravenous-medication-administration-what-to-know#iv-drugs

Most Common IV Push Meds on Med-Surg:

https://allnurses.com/most-common-iv-push-meds-t208488/

What are the top 20 drugs to memorize for Med/Surg?

https://allnurses.com/what-top-drugs-memorize-med-t290028/

Blood and Blood Products:

https://www.registerednursing.org/NCLEX/blood-products/

https://nurseslabs.com/blood-transfusion-therapy-nursing-management/

Emergency cardiac drugs: Essential facts for med-surg nurses https://www.myamericannurse.com/emergency-cardiac-drugs-essential-facts-for-med-surg-nurses/

Best wishes with the new position. ?

[Gyh]

On 8/3/2020 at 11:32 PM, Hoshio said:

In my setting, which is not an ICU, we do not allow Iv insulin per our policy by nursing. I’ve had some MDs that try to pressure nurses to do it here, but I simply tell them per policy I cannot administer that med, so either we do subq or I tel them they can come up and administer it themselves and stay with the patient to monitor them.

I had one moonlighter tell me after explaining our policy to them “it’s just insulin I don’t get the big deal”. The big deal that this isn’t an ICU, an IV insulin might kill my patient if done incorrectly ?.

Only different step meds I’ve done are either blood or tpn. Any high risk medication infusion will have a policy. Just lookup, and READ it.

For example, on the unit next to mine I remember a new nurses started a heparin drip on a patient and “looked up” the policy, but doubt she read it because the provider never ordered initial labs prior to initiating the drip which per our policy MUST be done before heparin is hung.

If you’re unsure about a policy, go up your chain of command to make sure you’re doing everything per your facility.

Also, depending on your facility providers may not need to specify rates for medications IV in their order. If you’re running things that don’t exist on a smart pump , always always always - verify the rate is acceptable for that medication with the pharmacist , and have them check your math and do a double check with another nurse. Basic mode is a scary mode on pumps, because the pump will do whatever you plug into it.

Thank you so much for all of this info! I am definitely going to spend time studying the protocols/procedures.

On 8/4/2020 at 12:02 AM, NRSKarenRN said:

Intravenous Medication Administration: What to Know

Most Common IV Push Meds on Med-Surg:

https://allnurses.com/most-common-iv-push-meds-t208488/

What are the top 20 drugs to memorize for Med/Surg?

https://allnurses.com/what-top-drugs-memorize-med-t290028/

Blood and Blood Products:

https://www.registerednursing.org/NCLEX/blood-products/

https://nurseslabs.com/blood-transfusion-therapy-nursing-management/

Emergency cardiac drugs: Essential facts for med-surg nurses

https://www.myamericannurse.com/emergency-cardiac-drugs-essential-facts-for-med-surg-nurses/

Best wishes with the new position.

Thank you for the info! I didn't know Med Surg nurses give IV chemo meds. I am a little shocked. I thought it was for oncology floor.

[NRSKarenRN, BSN, RN]

Smaller hospitals without oncology unit do administer as they usually only have ICU, Med Surg and ED hospital units.

[justjRN]

Hi there! CONGRATS on the new position!

I’ve worked med surg about 6 years now and these are my most common iv push meds

reglan, Pepcid, toradol, morphine,dilaudid,Lasix, solumedrol at times, protonix and zofran (lots of zofran!!)

IV meds are usually antibiotics flagyl,ancef,rocephin,vancomycin and zosyn are the most common.

Good luck to you!!