Question about IV push

[Bluepen]

When I give IV push, I will stop the IV fluids and disconnect the tubing and give the medication through the peripheral catheter. When I went to a different hospital for a family member's chemo appt, I noticed that a few nurses were giving the IV push meds from the IV tubing port that sits on top of the pump while the pump runs NS. I thought it was cool, since then it will go slowly without watching the clock. Plus it looked easier. However, I wasn't sure if it was something to try. Any thoughts? 

[chare]

I have a few questions for you.

1. Assuming that the medication being pushed is compatible with the IV fluid, why not administernthe medication through the distal Y port on the IV tubing?
2. Why do you think administering the medication from the proximal Y port "on top of the  pump" alleviates your responsibility to "watch[ing] the clock?"
3. Can you think of any reason why you might not want to administer an IV push medication using the proximal Y port?

[Bluepen]

All good questions. I have not tried it since I was not sure how you can control giving the medication slow within 3-5 minutes. They give meds before the chemo like Zofran, dexamethasone, etc. But maybe I will go to the next appointment and tell them not to do that to my family member. 

[chare]

Bluepen said:

... But maybe I will go to the next appointment and tell them not to do that to my family member. 

It might be best to ask them why they do it the way they do, rather than outright telling them not to do it.

If you do opt to tell them not to, be prepared to explain why you disagree with the what they are doing.

[BD-RN, BSN, RN]

Oncology RN in an outpatient infusion center here. 

First of all, we like to keep a closed system in the Cancer Center. Most of our patients have some level of immune compromise. Keeping a primary saline or dextrose line (depending on the chemotherapy that will be infused, and we always check compatibility as we have a lot of incompatibilities even with saline in some drugs) line flowing lowers the constant disconnecting and increased risk of infection, which increases risk of sepsis in many of our patients. This is especially true for patients with central lines, like portacaths or PICCs. 

Second, medications like ondansetron and dexamethasone have horrible side effects if given too fast.  Ondansetron can cause dizziness and bradycardia, and dexamethasone can cause nausea/vomiting or a horrible burning sensation or cramping in the groin. Your patient will literally jump out of the chair. We often dilute dexamethasone AND push it on the higher port, still pushing slowly over 2 minutes so it "floats" in. 

Third, yes, it helps control the rate. 

Now you know why we do things the way we do in the Cancer Center :)

[Bluepen]

Thank you so much! He does have a port. I am currently at the chemo appointment with relative and waiting to start. 

[chare]

BD-RN said:

[...]

We often dilute dexamethasone AND push it on the higher port, still pushing slowly over 2 minutes so it "floats" in. 

Third, yes, it helps control the rate. 

[...]

What difference does it make which port on the IV tubing a medication is pushed?

[londonflo]

Quote

When I give IV push, I will stop the IV fluids and disconnect the tubing and give the medication through the peripheral catheter. 

First of all NEVER disconnect tubing while expecting it will be reconnected.. Never. Reconnecting by you or whomever can introduce pathogens into the system. IVs are a closed system unless drugs are introduced via aseptic conditions.