Question about IV push meds

[sn0594]

I'm a student studying for an IV exam I have coming up and I have this question..

According to my instructors notes which I am typing verbatim you may never administer IV push meds when a continuous medication infusion or TPN is running (even if compatible or addressing incompatibility). Also, continuous infusions of meds should never be d/c. So my question is, what do you do if there is a continuous med infusion running in the only avail line and a stat IV push med is ordered?

[Virgo_RN, BSN, RN]

If the patient has a central line, then you use another lumen. If that is not an option for some reason, then you'll need to start a peripheral.

[sn0594]

If the patient has a central line, then you use another lumen. If that is not an option for some reason, then you'll need to start a peripheral.

At the hospital Im at RN's do not insert IV's, we have an IV team. I'm just trying to think about this in a roundabout way for purposes of the exam because they wouldn't give a choice to "call someone else to start a new line".

If the cont med infusion is running and you need to give a stat IV push can you temporarily turn off the pump, unhook the tubing, flush, give the med, flush again, and rehook the cont med or would that be unacceptable?

[cokristinug]

I would think that would be acceptable.

[RedCell]

At the hospital Im at RN's do not insert IV's, we have an IV team. I'm just trying to think about this in a roundabout way for purposes of the exam because they wouldn't give a choice to "call someone else to start a new line".

If the cont med infusion is running and you need to give a stat IV push can you temporarily turn off the pump, unhook the tubing, flush, give the med, flush again, and rehook the cont med or would that be unacceptable?

That is just embarrassing, not to mention that it is a tremendous waste of resources. I could not imagine being dependent on a colleague to obtain venous access for my own patient. You did answer your question however. Yes, a bolus of epinephrine/atropine/adenosine/etc... takes precedence over that expired TPN infusion.

[sn0594]

That is just embarrassing, not to mention that it is a tremendous waste of resources. I could not imagine being dependent on a colleague to obtain venous access for my own patient. You did answer your question however. Yes, a bolus of epinephrine/atropine/adenosine/etc... takes precedence over that expired TPN infusion.

I agree with you! In the nursing school through this hospital we don't even learn how to insert an IV! I'm going to feel extremely embarrassed if I decide to work at a different hospital upon graduation, not knowing how to do that skill.

[cokristinug]

As for the IV issue, my hospital has an IV therapy team as well. Most nurses don't even try to start their own IVs and automatically just call IV therapy. If your school has some kind of senior practicum where you can get extra experience in a specific area, you might want to consider ER. I did my practicum in ER and started a ton of IVs. Starting my new job on the floor I am much more confident in starting my own IVs, so it is a great place to learn skills!

[JulieCVICURN, BSN, RN]

We have an IV team at my hospital, but we only use them if we've tried twice and can't get access or if the patient is a known difficult stick. Otherwise, we start our own (although I get pulled to other floors all the time to do IV starts for them. I'm my own little IV team!).

I did not learn IV sticks in nursing school. We did it in one lab, and never did it on a real patient. You get good at it fast when you work in an area where you need to start them frequently, like ER or ICU. Also, we do stop infusions and flush the IV in order to give stat meds if we need to. The exceptions would be drips like nipride or dopamine or something that a bolus of could have serious consequences. And even then, a very slow flush would be acceptable IF you couldn't get any other access.

[SteffersRN87, BSN, RN]

I would stop the continuous IV infusion (and put a sterile cap on it)... flush with 10 mL's... give your IVP... flush with 10 mL's... restart your continuous IV infusion... and call it a day...

I will give an IVP through a maintenance if it is compatible...

[Virgo_RN, BSN, RN]

If the cont med infusion is running and you need to give a stat IV push can you temporarily turn off the pump, unhook the tubing, flush, give the med, flush again, and rehook the cont med or would that be unacceptable?

I would think this would be an acceptable alternative.

[Mimi2RN, ASN, RN]

We don't unhook the tubing, just stop the infusion, flush the line from the closest port, push the med through that port, flush again and restart your infusion. That's OK with TPN, but remember some infusions cannot be stopped and started, as they have to be tapered down. In that case you would need another PIV.

[Emergency RN]

the above answers all sound well and good in general, except that in the case of continuous med infusions; the drip could be awfully concentrated and you're going to bolus the patient with something potentially dangerous if given too quickly (like insulin or as mentioned by respondent julie, something vasoactive). afterward, the tubing will thus be devoid of any medication until the regular normal saline post ivp flush has been fully infused, delaying a return to regulated flow of the original infusion medication. this may be an issue with a patient that is highly dependent on that drug. the other issue is the iv push drug itself; some require very slow administration over several minutes through a continuously running line. this may further delay the return to primary infusion.

hence, at times, a second peripheral line may unfortunately be the unavoidable only option.

*** sidebar *** i used to work on an iv team, and boy, i can tell you some stories. but, i'll boil it down to this sentiment, which i've expressed to many a floor rn, "what... were you going to wait until you're pumping on his chest for me to get here, before even trying to start that line, lol...?" no offense, but if a patient really needs something urgently and you're there at the bedside, it is perfectly within your scope of nursing practice to start a peripheral iv. if you let a patient go south (and i don't mean florida) waiting for a doctor or dedicated iv nurse to perform the insertion while your patient is ready to push up daisies, it may not win over many jurors. my suggestion is, that if you're not yet confident in your iv insertion skills; ask around, take a class, even volunteer to follow someone around on your day off (ensure that you get your employer's permission first before doing this). seriously, iv skills are like learning to ride a bike. once you've done it a few times, you'll realize it isn't so hard after all; and the more you do it, the better you'll get.