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?

[tunafish1800]

Generally I check my drug info, if it's compatable I pause the drip... push the med and flush... and restart the infusion. If it's not compatable I saline lock administer the med and restart the infusion... pausing a med isn't the same as stopping the med.

[blondy2061h, MSN, RN]

I don't get if the continuous infusion running isn't something harmful it the patient gets a small "bolus" of it (NS, protonix drip, D5, etc) and the med running continuously is compatible with the medication being pushed, why the med can't be pushed through the y-site on the continuous medication's tubing.

[JulieCVICURN, BSN, RN]

I don't get if the continuous infusion running isn't something harmful it the patient gets a small "bolus" of it (NS, protonix drip, D5, etc) and the med running continuously is compatible with the medication being pushed, why the med can't be pushed through the y-site on the continuous medication's tubing.

Because there's still about an ml of medication in the tubing between the y-site and the patient. If you have a drug like Nipride going, that 1ml can bottom out a patient's pressure immediately. In addition, some critical patients are so incredibly dependent on the pressor or whatever agent you have going that they can't be off it for a moment. I've seen patients bottom out almost immediately when the IV pump starts beeping that there's been an interruption. In most cases, it's probably not going to be fatal, but it's still better to avoid that sort of bolusing if at all possible.

Starting IV's is one of my favorite things. I know it's weird, but it's something that I really wanted to be good at when I was in nursing school and made it a point to offer to do starts whenever they were needed. I'm pretty proud of my skill at starting them. Don't know why I love them so much, but I do.

ETA: I see you specifically said if it's not something harmful. If it's not, and it's something like TPN or fluid or an antibiotic, it's probably fine.

[NocturneNrse]

Don't worry about that.. I graduated from RN program, didn't get instruction on IV placement or any sort of venipuncture.. my hospital taught it to us. It's just not taught in school that often and the hospitals realize that and will help you. Don't fret. :)

[bill4745, 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

This is how I and every nurse I've worked with has done it for 15 years.

[RNKPCE]

Even if you learn to start IVs in nursing school you probably won't do enough to become proficient at them. I started one on another student nurse and one on a patient before I got my license. Practice, Practice, Practice. Watch experienced nurses, ask them for tips and most important don't say you can't start a particular IV until you've brought a tourniquet in and actually looked for a vein on that patient.

[inkedRN]

Stop the continuous infusion, flush the line with NS, push the med, flush with NS, restart the infusion. That's what I'd do.

Might not be what your instructor will tell you to do, but very little in real world nursing is the same as what you learn in school.

[JulieCVICURN, BSN, RN]

Even if you learn to start IVs in nursing school you probably won't do enough to become proficient at them. I started one on another student nurse and one on a patient before I got my license. Practice, Practice, Practice. Watch experienced nurses, ask them for tips and most important don't say you can't start a particular IV until you've brought a tourniquet in and actually looked for a vein on that patient.

...and don't tell the patient you haven't done very many. Attack it with confidence! Even seasoned nurses don't always get it on the first try.

[blondy2061h, MSN, RN]

Don't worry about that.. I graduated from RN program, didn't get instruction on IV placement or any sort of venipuncture.. my hospital taught it to us. It's just not taught in school that often and the hospitals realize that and will help you. Don't fret. :)

Yeah, we didn't get any instruction on venipuncture or anything at all either. Then when I was on orientation they said space was limited in the IV start class, so people from the BMTU didn't get to go since, "We never need to do IVs." And we rarely do. But on that "rare" occasion, I'm screwed, since I can't do them worth anything.

[prettygirllpn]

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.

That seems strange to me cause when i was in school, they had us start every possible IV that came around. I had quite a few under my belt by graduation.

[Altra, BSN, RN]

*** 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.

emergencyrn, i don't disagree with you at all - i really can't even conceive of caring for patients without having the skill and the means to do this. however, med-surg nurses at hospitals where i have worked just don't start lines. it's not unwillingness on their part - it's just not in their expected duties. the supplies to start a line couldn't even be found anywhere on the unit, even if they wanted to try.

[BluegrassRN]

I would also point out that staffing on such units accounty for the fact that ancillary services such as IV therapy, transport, RT, etc are available. Nurses do not have the time to start IVs or change central line dressings, as the IV therapy team is expected to do these tasks.