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Discussion

Push meds and Scope of Practice Interpretation

I'm having an issue with my states scope of practice, how to interpret it compared to how our facility operates.

First off, I'm practicing in Tennessee, I am not IV certified, and I do not have more than 6 months of experience as a licenced nurse. We did have IV training at the school I attended (limited to inserting and discontinuing) This is the first line in our scope of practice:

~~Intravenous (IV) Push Medications - The administration of intravenous push medications refers to medications administered from a syringe directly into an ongoing intravenous infusion or into a saline or heparin lock. Intravenous push does not include saline or heparin flushes. ~~

OK, so given that, my question is, is the following considered a practice of pushing a medication and exactly what is the definition of a push medication? (amount/time/ect)

When we receive an order for a medicine, say Rocehpin reconstituted (by vial not hand mixed) to equal a mini bag of 50ml's and it's hung as a secondary infusion at 50ml/h is this a push med? Would you say it's out of my scope of practice.

How about lasix if it is drawn up into a 5ml syringe then put on the pump to infuse as a secondary line... is this considered a push medication and out of my scope of practice if I am not IV certified?

Are these considered "directly into an ongoing IV infusion" as per my scope of practice?

I just want to know I understand it clearly it seems our facility may be skirting our scope of practice... I do not want to do anything to put my patients in danger or put my licence at jeopardy. Please, any input would be very appreciated.

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At my hospital, the rocephin diluted in 100cc NS bag and "piggy backed" into the primary tubing is considered a piggyback and not a push med. The lasix, which is actually drawn up in a syringe and pushed by you, is the med that is considered a push.

  • Author
At my hospital, the rocephin diluted in 100cc NS bag and "piggy backed" into the primary tubing is considered a piggyback and not a push med. The lasix, which is actually drawn up in a syringe and pushed by you, is the med that is considered a push.

The Lasix is screwed onto the pump and infused by the pump as a secondary infusion and at a slower rate, so is this considered "pushed" by me? Just making sure you understood it was on the pump and not "physically" pushed into a line. (essentially as a piggyback setup)

Just trying to clarify what you are saying about the Rocephin too; you call a piggyback not a push medicine. Is this because of the amount of fluid being 100mls or how the tubing is set up? or is it the rate at which it is infused at? What our facility uses is 50mls, run as a secondary infusion at 50ml/hr or 100ml/hr, so I am unsure if that changes what it's labeled as.

Gah, I'm so frustrated. I ask the same question to my preceptors, charge nurses, our DON, and my past instructors. I get different answers from everyone and what their interpretation is and what they "think". This is just making me sick to my stomach to think I may be putting my licence in jeopardy.

First, I'd call Pharmacy and question an IV infusion of Lasix. Seems contrary to the purpose of the drug, althought I've heard of it in rare cases. However, if it is truly an infusion, it is not an IV push. An example of an IV push of Lasix would be: I draw up 40 mg of Lasix and push it over a few minutes into a patient's IV access site or running IV line.

Next, check facility policy.

Third, you can always email or call your state BON with scope of practice questions. (Although it might be prudent to hold your opinion on your facility policy, if you think they're skirting your state's Nurse Practice Act.)

  • Experts

We actually run continuous infusions of Lasix all the time. We usually mix it 1 mL/hr = 0.05 mg/kg/hr and run it at 1-2 mL/hr. It gives us a gentle-ish continuous diuresis on our tiny cardiacs, allowing us to pull off all the extra fluid without compromising their blood pressure.

  • Author

I just wanted to post an update in case anyone was looking for the same information:

I called the TN BON today and asked for clarification of the scope of practice with administering push medications. I asked if administering medications through a syringe on a pump was considered a push medication. She stated that in fact it was not and what they consider a push med is holding the syringe in your hand and infusing a medication directily into an IV line. As long as it's not a medication/serum listed in the scope of practice that we cannot administer, it is within an LPN's scope of practice in TN.

I believed I had interpreted it correctly but it is such a relief to know for sure. Thanks for all your replies and advice too, this site is invaluable!

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