When to clamp tubing when doing IV push

[Katniss88]

I am a little confused about when to clamp tubing when administering medications by IV push. If you have fluids already running through an IV and you want to give a medication through the Y site when would clamp the tubing or stop the pump? My skills textbook doesn't clarify this, so I'm am confused.

[CC Wisconsin]

You clamp the tubing (you can just bend it to make a kink) ABOVE the Y site when you are pushing the med

[Racer15, BSN, RN]

I pretty much just always clamp above the y tubing when I'm pushing any med (assuming it is compatible), then do a saline flush, and then unclamp. I don't ever stop the pump, I just silence it when it hollers at me that their is an occlusion. Derp, I AM the occlusion.

[CC Wisconsin]

Here's an example of how I do my pushes. Let's say I have a primary line of NS running and I need to give an IV push of Zofran 4mg over 2 minutes. I clean the Y-site and attach the Zofran syringe. Clamp above the Y site, push in 1mg Zofran, unclamp the tube. 30 seconds later, I do this again (x3 to get the full 4mg in). That is how I was taught in school. I find it easier than trying to continuously push on the syringe. Plus then I don't get that annoying beep (seriously, IV beeps will be the death of me).

Hope that helps :)

[Katniss88]

Here's an example of how I do my pushes. Let's say I have a primary line of NS running and I need to give an IV push of Zofran 4mg over 2 minutes. I clean the Y-site and attach the Zofran syringe. Clamp above the Y site, push in 1mg Zofran, unclamp the tube. 30 seconds later, I do this again (x3 to get the full 4mg in). That is how I was taught in school. I find it easier than trying to continuously push on the syringe. Plus then I don't get that annoying beep (seriously, IV beeps will be the death of me).

Hope that helps :)

Thanks for taking the time to explain it. I was unsure, because yesterday my patient had a primary line with cardizem running, then I was to give an IV push bolus of cardizem and my instructor said I didn't have to clamp the tubing. Is there a trick or something to prevent getting the bubbles in the line after you unclamp the tube? So if you are going to give an IV push of medicine that is not compatible with the primary fluids or medicine running, would you take the line off and flush with NS then push the med and flush after, then hook the line back to the IV catheter?

[Music in My Heart]

If the line is on a pump and running, I don't bother clamping it since there's already positive pressure upstream of the port. Usually, the pump won't even alarm if I'm delicate on plunger.

If it's drip tubing, I do clamp even though ours have check valves. The problem is, a lot of the EMS tubing doesn't have check valves so if you don't clamp it, you just push the med up the line.

Is there a trick or something to prevent getting the bubbles in the line after you unclamp the tube?

Bubbles don't come from the clamping, they come from the port or the syringe. A few bubbles won't hurt anything so don't worry about it. I am pretty Type A so I'm pretty careful to maintain positive pressure on the syringe plunger while I unthread it from the port which eliminates are (and back flow on a saline locked line.

So if you are going to give an IV push of medicine that is not compatible with the primary fluids or medicine running, would you take the line off and flush with NS then push the med and flush after, then hook the line back to the IV catheter?

Yes... or else start another line.

[CC Wisconsin]

You are correct about incompatible meds. Stop, unhook the line, flush with NS, push med, flush again, then you can attach the primary line again. When doing pushes, just make sure that you are doing it at the closest Y-site to the patient.

As far as little bubbles...the previous poster is correct: small bubbles won't harm the patient. I have heard that up to an inch of air in the tube is fine. If it is bigger than a centimeter I usually flush it out. One way that you can prevent air bubbles at your Y-site is by properly priming the line. Always hold all of the Y-sites so they are pointing down. This will cause the air to rise out of the ports and into the main line. That air will then be flushed out with priming.

With IVs running on pumps, clamping the tubing for pushes probably doesn't matter because there is always positive pressure, like the previous poster said. However, if for whatever reason you don't have a pump (let's say in an emergency with a mass amount of patients...) you will need to clamp the tubing. I always clamp so that I am in the habit of doing it in case a pump is not available. :)

[turnforthenurse, MSN, NP]

If it's something like NS running, I don't clamp the tubing because as a previous poster mentioned, there is always positive pressure. If there is an incompatibility or if I'm not sure of the potential incompatibility (and say I have an abx running), I stop the pump, clamp the tubing (by pinching it) above the Y-site, flush with NS, administer IV push med, flush with more NS then unclamp the tubing and restart the pump.