Okay, so most aren't too bad to give and you literally just push the medication into the heplock access; like a Heparin IV boluses. A lot of medications given IV push, however, require the nurse to be aware of how many mg/min you administer. Example, 2mg of Diluadid (a pain killer) needs to be diluted with at least 5ml of normal saline and then pushed into to the IV over 2-3 minutes, PLUS you need to follow each IV push with an equal amount of a normal saline flush at the same rate.
How fast you push the medication can have ill effects on the patient. I remember from nursing school my instructor making a big deal about how if you give Lasix IV push too fast, you could cause your patient to go DEAF! That always stuck with me. I have yet to push Lasix, but I did have to push IV Dilantin last week.
Funny thing about Dilantin... it's suppose to help in preventing seizures, but if you push it too fast YOU COULD CAUSE YOUR PATIENT TO HAVE A SEIZURE!!! As noted from my preceptor, the previous day she gave the patient Dilantin push at a rate of 50mg/min. She got this rate from one of the drug handbooks on the unit. But our pyxis machine (holds and dispenses medications) warned to administer at a rate of 25mg/min. When I asked my preceptor, which rate I should use she said, "Let me put it this way, after I gave the patient Dilantin yesterday, she had a mild seizure". WTF?!?! Well, that made up my mind. Even though it was going to take me 8 mins to administer 4mls of this med PLUS another 8 mins to flush with normal saline, I didn't want to risk my patient having another seizure! It seemed like the longest 16 minutes ever!! Thankfully the patient was not alert or oriented (her brain had been fried after being in a diabetic coma for 2 days), and THANKFULLY she did not have a seizure!! Let me tell you though, every time she twitched her legs I prayed "please don't seize! please don't seize!"
Well, that was one of the more interesting (to say the least) medication administration experiences I have had. I'm sure there will be plenty more to come! Just wait for the day when I have to push Adenosine... that should be quite the story, as it would be for anyone :P
Ohh. I know we not allowed to do iv push. I always wondered why it was such a big deal that our instructor or other nurses have to do it. Now I realized it wasn't as easy as it seemed. The most common my pts get iv push are protonix, lasix, and a pain med I can't remember now. But I bet it was the longest 16 mins, Hehe.
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