Please, please set me straight!

[glovedgoddess]

Hi all!

This is something that I have just not been able to get straight in my mind!!....

The best practice ways of giving IV PUSH? To stop the pump? To leave the Infusion solution running? to kink the line? These are the questions!!

-> When I first started doing IV meds as a nursing student, I instinctively stopped the pump and flushed before giving the med. However, one occasion an RN was observing me give an IV antibiotic and she said "what are you doing you don't need to stop the pump, just let it run, attach the syringe and push the med through (no kinking,nothing)".

->Today, I was giving IV morphine and the RN observing me says to me after "I would kinked the line or stoppd the pump because there is a chance of a small amount of medication backtracking up the tube into the solution bag".

I have looked up the policy at the hospital I practice at and it says:

1) pinch off IV tubing above the port to be used, or clamp off tubing in the rollar clamp while injecting the med.

2) give med

3) resume IV infusion

---So to me this sounds like I leave the infusion running if it is flowing by an IV pump and just kink the line when pushing the med in. Although, do I leave the line kinked the whole time until med is pushed thru, or do I kink it in increments as I am pushing med so that little bits at a time are being pushed thru the tubing by the infusing fluid?

Because I feel like if I kept the IV tubing kinked the whole time while the infusion is still running there is going to be a lot of fluid building up and when I let go of the tubing after pushing the med thru, all this fluid is going to come rushing down and administer the med that is left in the tubing very quickly. BUT that is basically what the policy flat out says to do (Also the pump is most likely going to start beeping at me like crazy!)

--So if I didn't want the pump to beep at me than how about I just turn it off?? However, I think that there is still the same problem of a lot of the medication still being left in the IV tubing that hasn't even reached the patient yet and when I turn the IV pump back on it may go in at a faster rate than what is suggested.

*But a textbook of mine DOES say.. "if IV infusion is being administered via an infusion pump, pause the pump"

--What about gravity IV solutions and giving IV push meds?

--Also if the med is compatible with the running solution I don't have to do a pre-post flush, right?

--If I am giving two meds that are incompatible with eachother, but compatible with the running IV infusion solution how many mL's of NS flush do I use b/w the meds? 10 mL's?

--If the med is not compatible with the running IV solution do I stop pump, flush with 10mL(?) NS, admin med, flush with 10mL(?) NS, restart pump?

SORRY for so many questions at once.

IV push meds are haunting me!

Thank you for your much appreciated replies, if you could try and write them in step-by-step terms that would be absolutely wonderful!

[2ndyearstudent, CNA]

lol...this question drove my classmates nuts.

Here is exactly how you do it, right before you give the med:

1. Ask your instructor or preceptor how they would do it.

2. Do it that way.

Repeat as necessary when you get a different instructor/preceptor.

[glovedgoddess]

That's usually what I have been doing, but because everyone does it differently I haven't found what is the RIGHT way to do it.. lol sigh.

[tech1000]

I've always kinked the line.

[murphyle, BSN, RN]

Whether or not to stop the infusion for push medications depends on what's infusing. Many medications aren't compatible in solution, either premixed or at Y-sites. I keep a copy of Lexi-Comp's IV compatibility checker on my PalmPilot; you can also usually call the hospital pharmacy and they'll tell you whether the solutions are compatible.

In practice, if the running infusion is anything other than NS, I'll stop it, flush with NS and give the medication, then flush again and restart. (Exception: I'll give a med in D5W or D5 1/2NS if I can confirm that the med is compatible.) Given that the entire volume of an average IV set is 20 mL, a 10 mL flush syringe is plenty for both flushes (i.e. 5 mL per flush) if you're injecting at the closest Y-site. If further up the line, you'll need 10 mL per flush.

Hope this helps!

[smkiya, BSN, RN]

I agree with Murphyle. I always stop it if it's not NSS, flush, push, flush. I also disconnect the tubing, as I will not put another med in tubing with something other than saline.

[Suethestudent]

lol...this question drove my classmates nuts.

Here is exactly how you do it, right before you give the med:

1. Ask your instructor or preceptor how they would do it.

2. Do it that way.

Repeat as necessary when you get a different instructor/preceptor.

This.Is.Perfection. LMAO

[glovedgoddess]

"

I agree with Murphyle. I always stop it if it's not NSS, flush, push, flush. I also disconnect the tubing, as I will not put another med in tubing with something other than saline.

"

smikya- So when are you exactly disconnecting the tubing?? When something other than NS is running?? Wouldn't you just check the compatibility to avoid doing the disconnecting? Do you mean when there is a continous or piggyback med running through the line that you disconnect? even than you only mean when that med and the med you are giving are incompatible right?

[David Reinertso]

Some meds are incompatible with some iv fluids. Dilantin and dextrose, for instance. Unless your memory is amazing or your local formulary is small, you'll have to ask where's the compatibility chart.

The phrase "iv push" can mean to push over seconds, or minutes, or a half hour. It depends on the drug, the desired effect, etc. Our med reference often suggests something can be given iv push over 3-5 minutes or piggyback over 15-30 minutes. From that, I suppose this is because you need different equipment (piggyback tubing, pump, etc) to give something over 30 minutes, versus a minimal syringe and a needle for iv push. That's just my assumption.

Your second question is about pinching above the port when injecting into a running iv. I, like some above, assumed that a typical modern running i.v. line has a pump above the port you're using to give the i.v. push med. So it wouldn't allow the medication to go backwards upstream toward the pump.

I experimented in a kitchen environment, away from patients, using red food coloring as the "medicine", diluted in 0.9% NaCl. I found that, without pinching above the port, some "medicine" could literally float upstream. When I repeated with the medicine diluted in 5% dextrose instead of NS, little or no red "medicine" floated the wrong way.

I think the reason is that NS is physically lighter than most i.v. solutions. It may simply float upstream if you don't pinch really close above the port until you have flushed it into the patient.