What to do when there is limited access and you need to give IV push

[NewNurseinTraining, BSN]

Hello,

I am new in the ICU . One day I had a patient that was leaving for an urgent procedure the beginning of my shift. She only had a double lumen picc line for access, both infusing: one was infusing levophed and the other was infusing fentanyl & versed. I needed to give an IV push antibiotic before she went to her procedure. I was nervous that pausing the levophed drip and disconnecting the line to give the IV push medication through that lumen would increase her BP, and I was scared that giving it through the lumen infusing the fentanyl & versed would lead to unstable vitals.

I reached out to my preceptor and she said to go ahead and pause the levophed, and push the IV push through the  lumen that was infusing levophed. Unfortunately, her BP started increasing and delayed rolling her back to surgery a bit.

What could have been done differently? In this case should I have paused the levo drip, connect a syringe to the lumen and get some blood return, then give the IV push, flush, then reconnect the levo?

Thank you!

[atlnurse7]

What I would have done or what my preceptor would have told me to do, is to disconnect the Levo. Draw back on the line to try to get what is left of the Levo out of the line before you push it. If you end up getting blood return too, that’s fine. Just toss it. But then administer the antibiotic IV push. I’ve never given an antibiotic IV push. But that’s what my preceptor would have told me to do

I didn’t finish reading your post. Yes that’s what you should do in the future. You know more than you think you do! Trust yourself

[ghillbert, MSN, NP]

This is a horrible idea overall. NEVER push through vasopressor or inotrope ports. I would rather pause sedation and push a drug, or just put another IV in. I can't imagine any ICU preceptor advising to give a push through a levo port. 

 

[atlnurse7]

If there is limited IV access. Some places operate differently and maybe they couldn’t get another stick. In a perfect world, my preceptor would have probably come in and attempted to start another IV on him or her, which she normally can do even on people with bad veins. 

[chare]

I agree with @ghillbert, pushing meds through a line with any vasoactive medication is a bad idea.  Withdrawing the fluid from a line infusing vasoactive medications is just as bad.

If I was unable to place a PIV, and these medications were compatible, I would have infused them together and left the second lumen available.