06.09 IV Push Medications

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