Adding IV Push Medications Through an Infusing Primary IV Line

Adding IV Push Medications Through an Infusing Primary IV Line

Equipment
■ Syringe appropriate for medication volume and the type of line (e.g., peripheral IV, PICC, etc.)
■ Alcohol prep pad, or CHG-alcohol combination product and gauze pad.
■ Procedure gloves.
■ If you are administering through an intermittent device:
■ Two 5- to 10-mL syringes, or one 10-mL syringe with 2 to 10 mL of normal saline for flushing the line, depending on site and facility policy.
■ One 5- to 10-mL syringe containing 2 to 5 mL of heparin flush (or saline) solution.

Assessment
■ Be Safe! Assess the patency of the IV line before infusing. Post-Procedure Reassessment
■ Assess for complaints of pain or discomfort at the site.
■ Check the site for redness, swelling, tenderness, and other signs of infiltration or phlebitis.

Key Points
■ Be Smart! Determine the type and amount of dilution needed for the medication.
■ Determine the amount of time needed to administer medication.
■ Be Safe! Check the compatibility of the medication with the existing IV solution, if it is infusing.
■ Ensure the patency of the line before administration.
■ Prepare the medication from a vial or ampule or obtain the prescribed unit dose and verify medication with the order. Dilute as needed. Temporarily pause the infusion pump to administer the medication.
■ Thoroughly scrub all surfaces of the injection port closest to the patient with the alcohol prep pad or CHG-alcohol combination product. Use povidone-iodine solution (Betadine) only if the patient is sensitive to the other products.
■ Gently aspirate by slowly pulling back on the plunger to check for a blood return.
■ Flush the line before and after administering the medication.
■ If blood is returned (line is patent), pinch or clamp the IV tubing between the IV bag and the port, and slowly administer the rest of the medication.
■ If the IV is patent (e.g., positive blood return), administer a small increment of the medication while observing for reactions to the medication.
■ Be Safe! Maintain sterility.

Documentation
■ Document related patient assessment findings, such as the appearance of the IV site and patient complaints of pain or discomfort during IV administration.
■ You will usually document on an IV flow record and/or MAR rather than in the nursing notes.
■ Chart a nursing note only if there is a problem (e.g., if the patient experiences pain when you administer the medication).

Giving IV push medication through a primary line