Please, please set me straight!

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.

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.

I've always kinked the line.

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!

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.

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

"

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?

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.