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06.09 IV Push Medications

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Overview

  1. Purpose
    1. Some medications are given intravenously over a short period of time (1 to 5 minutes), therefore are best given via IV push as opposed to a slow IV infusion.
    2. You MUST know the ordered rate of infusion of IV push medications – check with Pharmacy
      1. Pushing too quickly can cause detrimental effects
      2. Emergency meds should be “slammed” (FAST)
    3. Meds that should be pushed SLOWLY
      1. Furosemide – too fast can damage kidneys
      2. Beta Blockers – too fast can cause heart block or severe bradycardia
      3. Opioids – can cause lightheadedness (“head rush”)

Nursing Points

General

  1. Supplies Needed
    1. Appropriate size syringe (based on volume of medication required)
    2. Medication vial + blunt tip needle to draw up medication
    3. Alcohol pad
    4. 10 mL Saline flush
    5. *Preferred method* – have primary IV fluids infusing
  2. Always administer IV push medications over the prescribed time.
    1. We are going to show you one way to do that safely

Nursing Concepts

  1. Steps and Nursing Considerations
    1. Verify provider order
    2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
    3. ALWAYS prepare medications at the patient’s bedside
    4. Gather supplies
    5. Perform hand hygiene
    6. Don clean gloves
    7. Let the patient know what meds they will be receiving
    8. Calculate the total volume of medication required
    9. Draw up medication in appropriate syringe
      1. If not administering immediately, you MUST label the medication syringe
        1. Drug, Dose
        2. Time, date
        3. Initials
    10. Calculate the volume of medication to be administered per minute
      1. Ex: 2 mL over 2 minutes
      2. 1 mL/min
    11. Now, calculate the volume of medication to be administered in 15 seconds divide by 4)
      1. Ex: 1 mL/min divided by 4
      2. 0.25 mL per 15 seconds
    12. With compatible IV fluids running:
      1. Program the pump for a “secondary infusion” of 15 mL at 150 mL/hr
      2. At that rate, 15 mL will take 6 minutes to infuse
        1. Allows for your 2 minute push AND time to flush the full line  afterwards
        2. **Note – if you have a longer IV push, program more volume at the same rate
    13. Attach your IV push syringe to the port closest to the patient
      1. Scrub the hub
    14. Push the partial dose you calculated for every 15 seconds.  
      1. You don’t have to push it evenly – just push it and count to 15
      2. Ex: push 0.25 mL, count to 15, push another 0.25 mL
    15. Repeat these partial doses until the medication is gone
    16. The IV fluids will carry the medication in slowly AND flush the line for you
      1. Having programmed it as a secondary, it should return to the primary infusion when the flush is complete.
      2. Double check that it returns to the primary infusion rate
    17. AFTER administration
      1. Document administration and patient’s response
      2. If using barcode medication administration
        1. Scan all meds before preparing
        2. Confirm administration AFTER giving to patient
    18. Discard all used supplies
    19. Remove gloves
    20. Perform hand hygiene
    21. For PRN meds, return in 15-30 minutes to evaluate response
  2. NOTE
    1. This is one way to push IV medications safely by dividing it into 15-second increments
    2. The most important thing is that you administer the IV push over the prescribed amount of time

Patient Education

  1. Indication and possible side effect(s) of medication(s)
  2. Signs to report to nurse or provider

Reference Links

Study Tools

Video Transcript

In this video, we’re going to give you a technique for IV push medications. Now, the most important thing to know is that you have to administer them over the prescribed time or you could do harm to the patient. The way we’re going to show you is just ONE possible way to make sure you get the right timing.

To start, this technique requires a little bit of extra math. First, calculate the total dosage required and draw that up in a syringe. In this case, we’ll say it’s 2 mL. Then figure out how many minutes it has to go over – let’s say it’s 2 minutes. Now you can find out how many mL in ONE minute – so that would be 1 mL per minute, right? Now, LAST calculation – divide that by 4 to find how many mL per 15 seconds. So now we’re left with this partial dose of 0.25 mL per 15 seconds. Write that down, because we’re going to use it in a second!
This method is a super safe way to do this, and it requires that you have a compatible IV fluid like Normal Saline infusing.
So here’s what you’re going to do. Go to your pump and program a ‘secondary’ infusion – you don’t have to have a secondary bag, we’re just using the pump to our advantage.
You’re going to set that secondary infusion to run at 150 mL/hr for 15 mL’s. That will be a 6 minute infusion – enough to flush your meds in AND flush behind it!
Now you’re going to clean the port closest to the patient and attach your IV push medication syringe there.
With that ‘secondary’ infusion running, you’re going to push the partial dose you calculated and count to 15. So – push 0.25 mL, count to 15, push 0.25 mL, count to 15, and keep doing that until you’ve given the whole dose. Then you can disconnect your syringe.
The fluids are going to push your drugs in for you, and you can be SURE that you haven’t administered it too quickly.
Once the secondary infusion is done, the pump should automatically switch back to the primary infusion – but always double check that it did.

Like I said, this is just ONE way to make sure you are safely administering IV push medications. But if you’re ever unsure how fast to push something, always check with your pharmacist.

And, of course, follow your 6 rights, document the administration, and monitor your patient for effects of the drug. We love you guys, go out and be your best selves today. And, as always, happy nursing!

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