New grad RN with questions on IVP meds

MAISY, RN-ER, BSN, RN · Jun 19, 2008

Most facilities have policies to follow with iv push medications. Push meds can depend on the patient in addition to the reccommendations. Imagine a 25 yo with sickle cell-5mg morphine will probably be nothing to them-but push that in an opiate naive 75 yo and you may be calling a code.

Or

Say you are giving Rocephin 1gm iv push-it's a 2-4 min push in my facility-well if I have a 20g in a large vein 2 minutes...if I have a 22g in a hand-4 minutes....if I have a 24 g in a finger-in a bag on a drip/pump over whatever the patient can tolerate. See what I mean?

I still use my best judgement when giving meds like this.

Hope that helped a bit

Maisy

gal220RN, BSN, RN · Jun 19, 2008

Not knowing what kind of patients you are taking care of, it is a little difficult to give you specific suggestions. There are the drugs you give frequently IVP- morphine, lasix, ativan, etc and then there are the ones you give every once in a while. Also, giving meds IVP can vary from location to location. In the ED, we pushed lots of antibiotics- something we would never do on the floor. You might benefit from a PDA that you can download drug information a look it up fast. Don't hesitate you call your pharmacy. They are a great resource. If they give you attitude, they are the ones that are being stupid, not the person smart enough to ask a question.

One other thing to remember. Always take the information you are given and place it in the context of your patient. There are very few meds out there that are ineffective given too slow- ex. adenosine. However, many many meds can have adverse effects if given too fast. For example, vancomycin (which of course is never given IVP) given over a period less than 60 minutes can cause Red-Man syndrome- fairly harmless, but alarming none the less. Morphine may be given IVP according to most nurses and drug references. However, if your patient is a fresh post-op T&A with co-morbities of obesity and upper airway obstruction, you might want to think twice before you push that Morphine. The last thing you want to do is have to intubate this guy emergently because of apnea. Not likely, but again, ugly!

One other suggestion, make a list of 20 or so meds you use all the time. Take an hour, do the research and write down each use, method of infusion or administration (dilution, concentration, infusion time), common incompatibilities and most common side effects. Make multiple copies and keep them close. Before you know it, you will be able to recall that information. And I guarantee you will gain the respect of your co-workers as they see your effort to learn and give safe care.

Ten to one- they ask for their own copy of your hard work!!

Good luck and Godspeed!

MikeyJ, RN · Jun 19, 2008

This would be a very large list -- there are many IVP drugs.

I would check with your hospital because most (I would hope all) hospitals have policies on IVP drugs and how quickly they should be pushed.

heaverboo · Jun 19, 2008

I work on orthopedics and some frequently pushed meds included: zofran, morphine, dilaudid, demerol, sometimes phenergan (been told this one is given really slow due to burning), benadryl, toradol, lasix every now and then (I know this has to be done slow due to the risk of tinnitus). What about narcan? Hope I dont have to use that one but just in case? I've thought about looking them up in the drug book. But for instance, I looked up morphine they say to dilute 2-10 mg in at least 5ml sterile water and give over 4-5 minutes? Never see morphine diluted or given that slow. Seems as if the drug book isn't practical. And another example: Dilaudid dilute with 5 ml of sterile water or NS and give direct IV 3-5 minutes? Maybe I'm just being paranoid now that I'm actually able to do these things on my own now (I was an LPN before and couldn't do certain things, with IVP meds being one). And when you ask a nurse on the floor they say "Oh, just do it slow". Any more comments/suggestions?

gal220RN, BSN, RN · Jun 19, 2008

First, yes!!! Narcan is absolutely given IVP- the faster the better if your patient is apnenic due to narcotics. However, realize you will reverse all the pain meds on board and possible wake some poor soul to hell. Also, narcan can have some refractory effects, requiring you to repeat a dose quickly.

You are right to respect the drugs you are giving. Don't be paralyzed by fear- experience will become your friend. Until then, play it safe and cautious. Follow the policies and procedures from your unit.

Owney · Jun 19, 2008

Heaverboo,

When I was in nursing school, way back in the 1980's, we were required to write 3X5 index cards for every drug each of our patients were given. It listed generic &/or trade name(s), indications, dosage, side effects, precautions and nursing considerations.

I went to work in the emergency room of a major trauma center directly from school (nearly unheard of then). I remember at my first code, a pharmacist handed me a syringe and said, "push this." Remembering my education that said, "NEVER give a drug unless you know all about it", I made it a point to ask the pharmacist about each drug given in ACLS. She was very helpful in giving me print-outs of the ACLS hospital formulary to study in preparation for the next course.

I made it a point never to give a drug, especially IVP without someone (pharmacist, physician or experienced nurse) telling me something about it. I do not believe anyone ever treated my questions as stupid ones. During my last days in E.R. I still had another nurse check my pediatric dosages and other "brain fart" math problems, and never hesitated to call the pharmacy if I could not find out what I needed to know before giving a med of which I was unsure.

I worked in the emergency rooms of over a dozen hospitals in Southeastern Michigan; sometimes as staff, and more frequently for an agency. Although not always complete with nursing implications, every hospital I worked in was required to have a medication formulary which must list every drug stocked by the hospital. Some hospitals go so far as to require testing on each medication before a nurse can administer it.

Hope this helps,

Owney:loveya:

Rae83 · Jun 19, 2008

First off read you policy, second refer to your drug book and if you are still uncertain or don't have time to look it up call your pharmacist that is what they are there for. No question it stupid especially when it comes to caring for your patient.

BradleyRN · Jun 19, 2008

Even when a drug says "may be given undiluted", i always like to dilute to 10cc with NS. It makes it easier to push over a length of time than trying to give a .5-1cc over a few minutes. IV books are not impractical. They are telling you the right way. If you see others push things faster, it doesnt mean that the book is wrong, it means they are. Also, you dont have to keep your thumb on the plunger for 4 minutes slowly pushing a drug. Slowly push about 2cc, and then remove your hand and wait for the rest of the minute to go by, and then slowly push another 2cc, and so on. I have a PDA (palm based) with a program called "iv meds" based on the book by Elsevier/Mosby, "Intravenous Medications". It is very helpful.

heaverboo · Jun 20, 2008

Thanks for all the input, I may have a talk with the pharmacist on our floor one day. We keep a pharmacist on the floor all day because they make our coumadin dosages and being an orthopedic floor she has to do every patient. It's awesome having one there for every little question!