1. IV Push

2. Direct Injection, Bolus, IVP Administration of a drug directly into the venous access device through the proximal injection port on a continuous infusion Purpose: Achieve rapid serum concentrations

3. Caution Greater risk of side effects Many drugs have maximum rates at which they may be administered. The rate of injection must be timed and the drug injected in increments. Drug may be incompatible with the infusing solution or heparin may be in the tubing, flush with NS before and after.

4. CAUTION IV drugs are potent and rapid acting. Never infuse IV push drugs more rapidly than recommended by agency policy or pharmacology literature. Some drugs may require further dilution after reconstituting fro IVP administration. Carefully read package inserts and reputable drug resources for minimum dilution and minimum time for IV administration.

5. Caution Use needle free system, if needle is used it should not be more than 1” as it can puncture tubing Example IV Lasix IV incompatibilities Solution Fructose 10W, invert sugar 10% I Electrolyte 2 Amiodorone, epinephrine, Gentamycin, Solu- cortef, Verapamil, pepcid. 40 mg or a fraction must be given over 1-2 min,

6. Rate of Administration Life threatening reactions (time related overdose or allergy) are frequently precipitated by too rapid rate of injection. Drug literature and institutional guidelines recommend an acceptable rate per minute or per increment of time for IVP adm. Most timed IVP are 1-5 min.

7. IV Administration For smooth manual administration of IVP drugs calculate the incremental volume to administer over 15 second interval. You should time the administration with a digital or sweep second hand watch or clock.

8. Example Order Ativan 3mg IV Push, 20 minutes preoperatively. Supply Ativan 4mg/mL with drug literature guidelines of “IV infusion not to exceed 2mg/min” How much Ativan would you prepare?

9. Math Step 1= Convert : no conversion necessary Step 2 Think you want to give less than 1mL Step 3 Calculate D xq =3mg X1mL=0.75 » H 4mg »What is the safe Infusion time?

10. Insertion time D/HxQ= 3MG/2MGx1 MIN= 3/2MI= 1 ½ MIN Or use ratio and proportion to calculate the time required to administer the drug ordered 2mg = 3m 2x=3m X= 3/2= 1 1/2min. 1min x min Administer 0.75 mL over 1 ½ min

11. How much should you infuse over 15 min? Convert 1 min= 60 seconds 1 ½ min= 90 seconds 0.75 mL x 90 sec. 15sec 90X=11.25 X= 90/11.25=0.125 =0.13 of Ativan 4mg?mL infused IV push every 15 seconds will deliver 3mg of Ativan Use a 1mL syringe and and 0.13 q 15 seconds