Reason for not giving IV push med too fast?


  • Specializes in med/surg, ortho, gyn, LTC, home health. Has 13 years experience.

Hi everyone, I am in an RN refresher course, my instructor asked me point blank "what is the reason to give an IV push med slowly?" My original thought was fluid volume overload (which occurs with IV fluids because the volume), but could not immediately think of the physiological response of the body when a IV push med is given too fast.

I know it probably depends on the med itself, but in general, can anyone answer what happens when an IV med is given too fast?

5 Answers


Kenneth Oja, PhD, RN

1 Article; 18 Posts

Specializes in teaching, research, and evidence-based practice. Has 19 years experience.

You're correct in noting that it depends on the medication, which is why it's crucial for nurses to understand and follow the appropriate guidelines for safe medication administration.  

Pushing certain IV medications too fast can result in adverse reactions and/or harm to the patient including: 

  • Anaphylaxis 
  • Shock or cardiac arrest 
  • Rapid drop in blood pressure 
  • Respiratory depression or arrest 
  • Damage to veins leading to thrombosis or phlebitis
  • Decreased therapeutic effect

Knowing the rate at which an IV medication can be administered also falls under the Five Rights of Medication Administration that we all learned in nursing school. Following these rights when giving medications reminds the nurse to ensure they have the right patient, the right drug, the right dose, the right route, and the right time. So, if the route is IV, the nurse must know the right rate at which that medication can be delivered via that route. 

If you don't know the rate at which an IV medication is delivered, it's your responsibility as a nurse to find out. Look it up in a drug guide, consult with a pharmacist, or check the instructions from the manufacturer. Just don't give it without knowing!

MedicalLPN, LPN

241 Posts

Specializes in Onco, palliative care, PCU, HH, hospice.

Typically depends on the drug, for instance pushing IV Ativan rapidly can cause cardiac arrest, pushing IV Dilaudid, Morpine, or Fentanyl rapidly increases the risk of respiratory depression and sedation.

Also cardiac drugs such as Lopressor or Cardizem should be pushed over 5 minutes (except during a code situation or other wise specified by MD) slamming these types of drugs can cause serious cardiac dysrhythmias and cardiac arrest.

I also always push IV Lasix slowly because if pushed rapidly it can cause deafness. Before administering any drug you're unfamiliar with always consult your drug book, charge nurse, or pharmacist on staff. Hope this helps!

iluvivt, BSN, RN

2,773 Posts

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

I think your instructor was looking for the term "speed shock". Speed shock is the rapid introduction of a foreign substance into the circulation. It can cause severe HA, flushing, and even resp and circulatory collapse or symptoms. Always dilute as recommened and give at recommened rate. Also if given too quickly you may see an overexagerated response specific to the drug.


149 Posts

Specializes in Cardiac, Hospice, Float pool, Med/Peds.

Also, the medicine could sting the patient. I always go slow with my IV meds because I dont' want to put my patients at risk for any of the above responses...;)

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

142 Articles; 9,981 Posts

Specializes in LTC, assisted living, med-surg, psych. Has 26 years experience.

Some meds are very hard on veins even when diluted, and can ruin them.......not a pleasant experience. The trouble with IV pushes is that once the drug is in, you can't get it back; of course, the idea is to get them into the circulation quickly and (hopefully) produce beneficial effects. However, pushing the drug over several minutes gives you a chance to monitor the patient and stop if he/she responds badly.

Sometimes it does become necessary to push an IV med quickly, but in the majority of non-critical situations, even small volumes of medication should be pushed over at least one minute to avoid speed shock and other problems. Better safe than sorry.