NICU IV push meds and flushes

[PEDSOBRN]

When giving iv push meds with running iv do you use port closest to iv site or port on iv tubing? Do you pinch off iv tubing?How much do you flush with before and after?

[prmenrs, RN]

The port closest to the pt, and yes. How much to flush w/depends on the drug and the compatability w/the infusing solution. The size of the baby might influence flush amt, too.

[umcRN, BSN, RN]

we always have dedicated med lines that attach as close to the patient as possible. We run ALL our meds on pumps doesnt matter if its 0.2ml or 10ml. Typically on the really tiny ones I will only run a flush amount big enough to clear the med line tubing (about 0.5ml). Our pumps will automatically calculate how long to run the flush so that the remaining med gets to the patient at the same rate it was running at initially. For example if you're giving 0.8ml of gent it should go over 30 minutes but when the med is done on the pump (aka the syringe is empty) there's still half of that med running in the tubing, the pump asks if you want to run a flush and you say "yes" and the how much, it will continue to run it at the same rate the med was so the baby doesn't get the last half of that gent too fast.

[Jory, MSN, APRN, CNM]

I have some different advice...if the directions call for a slow push, which is generally about a minute ie. Ampicillin, I don't think it is necessary to put it on a pump and you can use the port closest to the baby, with one exception. I would only flush with 1 ml just to make sure that all the medication leaves the port.

If you have a super tiny tee-tot that has a PICC and a secondary that is going to have the PICC for a long time, every effort needs to be made to:

1. Guard the patency of the secondary with your life.

2. Minimize the amount of heparin the baby is getting.

So if you have a baby that is on multiple meds that are not push and are compatable with TPN, put it on a pump so you don't have to hep-lock...be sure to run a flush behind at the same rate to clear out the tubing. I have seen tons of PICC secondaries occluded because some nurses don't want to hep-lock the secondary if medications are a couple of hours apart, which is silly if you factor in that it only takes 30 minutes for a secondary to become occluded.

You don't need to pinch off the IV tubing if the medication is compatable. You should never pinch off the TPN to give a med over 30 minutes or an hour...if it's not compatable, then you need a secondary access. Medications are not a substitute for nutrition and fluids.

[MiniBabyRN]

We put all our meds on a syringe pump, the only things that I have seen truly pushed on my unit are things that need to be given as quickly as possble, like Epi or adenosine. We aso have portless IV tubing, so the medication line is Y'ed into the maintenance fluids or TPN. We usually flush with 1 mL afterwards, which is just enough to clear our med tubing.

[bmsrn]

We also have a dedicated med line, and our TPN tubing is portless- so there is no such thing as giving it to the closes port. Things like Amp and caffeine I'll push through my medline, then run my flush over a set amount of time. Our med line tubing is 0.7ml so I'll run that much.

When we have meds that are not compatible with TPN or lipids and we have limited access, we do "delay" our TPN/lipids for 30 minutes. I understand that it's not a substitute, but at the same time nothing has ever happened. I'd rather do it this way than have an IV just for 1 medication that is not compatible. It seems like an infection risk to me to have more access then needed.