What is an IV push medication?

1. 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.

2. 6 reasons for medications to beadministered IV push. • Rapid onset • Improved serum drug concentrations • Able to administer when NPO • IM painful • Some drugs can only be given IV • “Loading dose”

3. Describe 4 complications r/t via IVP meds • Incompatibilities • Physical: • Chemical: • Therapeutic: • Speed shock: • Vascular irritation • Rapid onset of action

4. IV Policy from Student Handbook • In semester 2 and 3, students will give IV push medications only under the direct supervision of their instructor.

5. 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

6. 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

7. Additional steps prior to giving an IVP med • Compatibility • Rate of administration • Need to be diluted?

8. Example from Gahart: Metoclopramide 10 mg IV q. 6 hours • 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.

9. 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]

10. IV push med through a peripheral lock SAS: • Saline • Administer med • Saline What type of adaptor do you have? Positive pressure or negative pressure? Reminder: The technique differs!!

11. IV push med through a Central line lok Remember w/CVAD: 10 mL syringe or larger SAS • Saline • Administer med • Saline • Positive pressure access device: • Remove syringe, then clamp tubing

12. 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)