Zofran: IV push or Piggy Back?

[Testa Rosa, RN]

I was taught by my experienced preceptor that any amount equal to or over 8mg of Zofran needs to be injected into a 50ml bag (D5 preferred but NS OK if pt is diabetic) and hung as a piggy back; however, after working on the unit for awhile I've come to realize that every nurse does it differently.

Some nurses draw up 4mg of Zofran into 10cc of NS. If they are giving 8mg they just push two syringes instead of one, followed by 10cc of flush, others just draw up all 8mg straight up without dilution and push slowly bumping up the primary infusion fluid to 100cc for the brief time they are at bedside.

I was wondering what is the "right" or "best" way? Maybe one doesn' exist as I've researched this and haven't found any.

How do you do this?

Thanks, TR

[ed321]

Administer 8mg in NS 50ml IVPB over 15 mins.

[iluvivt, BSN, RN]

I work in a very busy ER. Zofran 4-8mg is routinely ordered. I push it over 2-3 min in a 10cc syringe. 5cc if it's a Paediatric pt. Followed by a minimum 3 cc flush. Sometimes 10 if I have one in my pocket. I've never had issue w this method. I use the same process for Reglan 10 mg. However; "back in the day" it was customary to use a 50cc IVPB for Reglan. To the Nurse who suggested pushing Phenergan IV, please be sure your IV is well placed, in a LARGE vein and at least an 18G. Extravasation of the periphery is a nasty thing!! I advise ALWAYS diluting Phenergan yes, even 12.5mg unless you're utilizing a central line. Benadryl IVP will cause bronchospasm if pushed without dilution and too quickly but it can be administered IVP. Best practice; check with your Pharmacy, know your Hospital's Policy and Procedures and departmental protocols. What works in an ER may not be feasible in an ICU

An 18 gauge cannula for a drug that is irritating is not the correct thing to do.You always want to use the shortest and smallet cannula that will meet your needs. In this case pick a large, soft,full vein not at an area of flexion and pick one with a good amount of tissue around it...avoid the hand for this reason and avoid the ACF .(area of flexion and also many have a difficult time detecting an extravasation/infiltration in this area).You will get much better hemodilution around the cannula and less vein wall irritation with a smaller gauge.Same applies for other vesicants such as Dopamine and Calcium Chloride and others.Not sure why there is misperception that a large cannula is needed but its incorrect!