?? re: giving drugs through a maintenence infusiong

UM Review RN, ASN, RN · Apr 3, 2008

The best way to make sure that the patient is getting the drugs uniformly is to dilute and push from the closest port. I personally don't like to let the med float in with the IV fluids, I don't think that's all that safe - or guaranteed.

You might check with your Pharmacy on that question, though. They often know the answers to things like that and are a great resource.

PICC ACE · Apr 9, 2008

When you are pushing a med in a running line,the rate doesn't matter. Whether the rate is 500 or 5 ml/hr,you deliver the dose over,say,5 minutes. The concentration actually entering the patient is different,but 5 minutes is still 5 minutes.

Best practice is to use the injection site closest to the patient and there are a reasons for this. Imagine that you have are giving a med through a higher port and the patient picks that very moment to code or have an anaphylactic reaction to what you are giving. You now have an entire IV set full of something your patient doesn't need or is reacting to. Do you want to waste time disconnecting from the patient,aspirating from the IV device,taking the tubing out of the pump,flushing the line,reconnecting and THEN think about rescuing the patient? Probably not. Another example--let's say you hung a piggyback of Cipro 15 minutes ago and now you need to give your patient some sort of prn. Since Cipro should be considered incompatible with everything and you have an IV set full of Cipro,the only way to give your prn is to stop the infusion,flush the set from the closest port and then give the med. No practical way to do this if you use the higher ports.

Good luck to you.

Zookeeper3 · Apr 11, 2008

My practice is that with these lines, one has a stopcock at the hub. Usually the NS line where antibiotics go is hooked up to run straight into the line and the "open" port faces out. When I want to push, say morphine, I pause that line- (put a 10cc syringe NS if there are additives to the fluid) to the available stopcock port, turn the stopcock closed to the fluid and flush or inject the med, then I flush with 10cc NS-turn the stopcock back to open the fluid line and restart the infusing fluids.

For some reason my stopcock irritates some and others have begun using it for our frequent IVP meds. It's closest to the line, you control the drug entering by flushing slow as you deem safe and compatability issues are eliminated. Plus you're not disconnecting lines which increases contamination/infection risks.

Great question!

9309 · Jun 21, 2008

However you do it, you should know what the volume of the line is.

I have seen some practices that demonstrate that the nurse has nor taken this into account. For example:

The closest port to the patient may have a 1 cc volume. Very slow push of 1 cc of medication, followed by a much faster flush. The nurse believes he/she has delivered the med to the patient slowly. What they have done is delivered the med slowly to the iv tubing, and quickly to the pt.

Another example would be using a high port on a slow running iv, and having no idea when it is actually making it to the pt. Lets take an iv of ns running at 60 ml/hr. (an unusual rate, but good for this example) Getting 60 ml an hout, would be 1 cc a minute. If my distal port is 10 ml away from my pt, it will take 10 minutes to get there. As far as being well diluted using this method, I am skeptical. I think that for the most part, it probably travels as a bolus, with some dilution happening.

In the right situations, I will use a maintenence fluid line for meds, but it is a conscious decision taking into account the above factors.

9309

cardiacRN2006, ADN, RN · Jun 21, 2008

When you are pushing a med in a running line,the rate doesn't matter. Whether the rate is 500 or 5 ml/hr,you deliver the dose over,say,5 minutes. The concentration actually entering the patient is different,but 5 minutes is still 5 minutes. .

I think what the OP is saying is that people aren't actually giving it over 5 mins. What they do is pick the furtherst port, injecting it all in at once, and letting the MIV push it in over whatever rate that it's running at.

Not best practice at all, but I see lots of people do it.

gilf7243 · Jul 27, 2008

I have never heard that pushing Dilauded and Ativan was unsafe uless the wrong dose is given. I was never taught to use the most distal y port. I always have used the closest to the patient. Of course I make sure first that it is compatable with the current fluids running and I don't push it fast but steadily over 1-2 minutes letting it mix with the maintance fluid as it goes in. Not sure how else to answer your question. Hope this helps.

MBCRNA · Sep 14, 2008

I understand your question. You want to know how fast the medication is reaching the patient and how long does it take the entire pain med etc to infuse in (and over what time period). Okay, it depends. First, like a previous person stated- you have to know how many cc's run the length of the central line port or INT. Then you have to know how many cc's it takes to flush from the port that you are questioning of the IV tubing to the end. The central line will have that information on the box it comes in and you could easily take a flush and clamp off the port that you are going to infuse it from and push in however many cc's it takes to get to the end. Now, add that to the length of the central line lumen that will be your total cc's. Okay, the important question is how many cc's have you drawn up for your pain med (most likely 1 ml). Next, how fast is your IVF infusing? Say 60ml/h... okay example:

Pain med: 1 ml

IV tubing from port to end: 2 ml

central line lumen: 3 ml

IVF: 60 ml/h

Total length for med to travel: 5 ml

Med is 1 ml

IVF is 60 ml/h so 1 ml/min...so med infuses at 1 ml/min and your line is 5 ml then your med will go in over 5 minutes...possibly 4 since you are gonna bolus that 1 ml by pushing it in quickly (so it takes up 1 ml of the line immediately).

Hope this helps... This is best way can explain but its just an example. I am guessing as far as how long the line is.

jsm12 · Sep 14, 2008

Because you want the medication to work as quickly as possible especially with analgesics it is best to dilute it in syringe first then give it at the nearest port.