1. What is an IV push medication?
N26:IV Push Medications
4/13/2017
What is an IV push medication?
Davis’s Drug Guide: “Direct IV”
Gahart: “IV injection”
Also called IV “bolus”, or just bolus.
Bolus = “concentrated medication or solution given rapidly over a short period of time; …direct I.V. injection or I.V. drip” (Phillips, IV Therapeutics, p. 625)
Institutional as well as pharmacological guidelines must be followed.
Cabrillo College ADN ProgramC Madsen RN, MSN

2. 6 reasons for medications to be administered IV push.
N26:IV Push Medications
4/13/2017
6 reasons for medications to be administered IV push.
Rapid onset
Improved serum drug concentrations
Able to administer when NPO
IM painful
Some drugs can only be given IV
“Loading dose”
Cabrillo College ADN ProgramC Madsen RN, MSN

3. Describe 4 complications r/t via IVP meds
N26:IV Push Medications
4/13/2017
Describe 4 complications r/t via IVP meds
Incompatibilities
Physical:
Chemical:
Therapeutic:
Speed shock:
Vascular irritation
Rapid onset of action
Incompatibilities
Physical: visible precipitation forms.
Chemical: changes in molecular structure or pharmacological properties; may or may not be physically observable.
Therapeutic: therapeutic effect of a drug altered (increased or decreased) by another.
Speed shock: a systemic reaction to a substance rapidly injected into the bloodstream.
Headache, syncope, flushed face, chest tightness, irregular pulse, shock.
Best tx: PREVENTION
Vascular irritation, pain at insertion site: may need to dilute more, or give slower. (assuming site w/out phlebitis).
Rapid onset of action: don’t have much (or any) time to reverse the effects, and can’t call it back (like syrup of ipecac, gastric lavage w/ po)
Cabrillo College ADN ProgramC Madsen RN, MSN

4. IV Policy from Student Handbook
N26:IV Push Medications
4/13/2017
IV Policy from Student Handbook
In semester 2 and 3, students will give IV push medications only under the direct supervision of their instructor.
Cabrillo College ADN ProgramC Madsen RN, MSN

5. Cautions Don’t mix 2 drugs in syringe, even if compatible
N26:IV Push Medications
4/13/2017
Cautions
Don’t mix 2 drugs in syringe, even if compatible
Wait until later to use?
Label all syringes
Always give IV push meds under the direct supervision of your instructor.
Don’t throw the ampule/vial away
Cabrillo College ADN ProgramC Madsen RN, MSN

6. Prior to giving a med IV Push:
N26:IV Push Medications
4/13/2017
Prior to giving a med IV Push:
5 rights
Generic and brand name
Classification
Why getting drug – expected effects
Is this an appropriate dose?
Patient teaching
Onset & duration of action
Cabrillo College ADN ProgramC Madsen RN, MSN

7. Additional steps prior to giving an IVP med
N26:IV Push Medications
4/13/2017
Additional steps prior to giving an IVP med
Compatibility
Rate of administration
Need to be diluted?
Cabrillo College ADN ProgramC Madsen RN, MSN

8. Example from Gahart: Metoclopramide 10 mg IV q. 6 hours
N26: IV Push medications
Example from Gahart: Metoclopramide 10 mg IV q. 6 hours
4/13/2017
Dilution:
May be given undiluted if dose does not exceed 10 mg. For doses >10 mg dilute in at least 50 mL of D5W, NS, …, and give as an infusion. 
Rate of Administration:
Too rapid IV injection will cause intense anxiety, restlessness, and then drowsiness.
IV injection: 10 mg or fraction thereof over 2 minutes.
Infusion: Administer over a minimum of 15 minutes.
Cabrillo College ADN/C.Madsen RN, MSN

9. Compatibility example: metoclopramide
N26: IV Push medications
4/13/2017
Compatibility example: metoclopramide
“Consider any drug NOT listed as compatible to be INCOMPATIBLE until consulting a pharmacist”
Manufacturer lists as incompatible…
Sources suggest the following compatibilities:
Additive: Manufacturer lists…
Y-site: All drugs listed by the manufacturer as compatible under Additive. Other sources add [A long list, alphabetical]
Cabrillo College ADN/C.Madsen RN, MSN

10. IV push med through a peripheral lock
N26: IV Push medications
4/13/2017
IV push med through a peripheral lock
SAS:
Saline
Administer med
What type of adaptor do you have? Positive pressure or negative pressure?
Reminder: The technique differs!!
Cabrillo College ADN/C.Madsen RN, MSN

11. IV push med through a Central line lok
N26: IV Push medications
4/13/2017
IV push med through a Central line lok
Remember w/CVAD: 10 mL syringe or larger
SAS
Saline
Administer med
Positive pressure access device:
Remove syringe, then clamp tubing
DO use ‘push-pause’ technique with last saline. Not necessary to use with med, or 1st saline.
Cabrillo College ADN/C.Madsen RN, MSN

12. N 26 Patient Controlled Analgesia
April 17
Skills Competency
Saline lock flush – either peripheral or central (all scenarios will include).
IVPB (bag w/secondary tubing)
Gentamicin Sulfate
Ceftriaxone Sodium (Rocephin)
Levofloxacin (Levaquin)
Central line dressing change
IV push
Pepcid
Reglan
Lasix (furosemide)
Cabrillo College ADN/C. Madsen RN, MSN