Clinical Skills - IV Push Medication
by Ellis Parker March 16, 2022 Updated: August 09, 2023 5 min read
Hi. I'm Ellis with Level Up RN. In this video, I'll be demonstrating how to hang an IV piggyback or a secondary line as well as how to perform an IV push or bolus medication. I'll be following the steps that are on our clinical nursing skills cards. So if you've got this deck, grab these cards, and you can follow along with me. If you don't have the deck and you're interested in getting one, head on over to LevelUpRN.com. A few quick tips before I get started with the demonstration, when I'm using a saline flush, I need to make sure that I eject the air. So I'm going to go ahead and demonstrate that for you. So you've probably seen this in TV and movies, right? They always do this. I did a little bit extra that time. That's because there's air and it's pressurized. And so if I don't pop that before I use it on a patient, it not only has an air bubble in it, but it can be really difficult to get it started. So after I open a fresh saline flush, I need to go ahead and eject that air.
The second thing I wanted to note is that if I'm using a saline lock, so if my patient doesn't have a continuous IV running, the clamp should be clamped when it's not in use. And so I have had students that approach the patient to administer a saline flush or an IV push medication, and they attach it to their patient's saline lock. And they're pushing and pushing and pushing and pushing, and they're so confused why it won't go in. Well, it won't go in because their lock is engaged. So if there is no medication or fluids running through their IV, it should be locked, and it probably is locked. So make sure that the clamp is unclamped before you attempt to give that patient an IV push or a flush.
Before I give an IV push into a saline lock-- or what that means is just that this saline line is not connected to a pump of any kind. Before I can do that, I've already done my hand hygiene, put my gloves on, and I've drawn up my medication. So if your facility does not use these medicated caps or disinfectant caps, you're going to want to get a disinfectant wipe and clean that off. Well, I'm going to say we're using these caps today. So I'll remove my cap, retrieve a saline flush, connect that to my needleless port or my Luer lock, and I'm going to flush my line with at least three to five milliliters of normal saline. The reason I do this on a saline lock is just to double-check that this IV is still patent. Because I don't have something flowing through it, that proves to me or that I'm able to assess is actually running through a patent IV site, I need to double-check that with normal saline because normal saline could be safe if that IV were not in the vein any longer. So if normal saline were to get into the surrounding tissue, that might be okay. But what if my medication would be dangerous to get into that surrounding tissue because it is intended for intravenous purposes? So I've gone ahead and flushed.
I then connect my medication syringe, and I push that at the recommended rate that I can retrieve from a drug textbook or online or from my pharmacy. So I'll push that at the drug recommended rate. And I need to follow that up with another flush of normal saline, about three to five milliliters, just to make sure I've cleared the medication from this extension tubing. I'm pushing that at the same rate that I've pushed that medication. Once I'm done with my saline flush, I can go ahead and lock my saline lock, remove my flush. And then I'm going to reapply my cap if I used disinfectant caps at my facility. And your patient's now received their IV push medication.
Before I can give an IV push medication, I have already done my hand hygiene and got my gloves on. Now, this IV push is going to be done with a patient who is connected to primary tubing. So they're receiving some type of fluid or medication. So that first step is to check compatibility between what's running and what I'm pushing. I then can pause my pump. And then if there is a clamp on this tubing, I can clamp it, or I can just fold it in half so that when I administer the medication, it doesn't backflow up the line. I'm going to then take this protective cap off of my port. If I don't have protective caps used at my facility, I can just use an antiseptic swab to clean that port off. I'm going to take off my port and set it aside. I'm going to get a 10-milliliter syringe of normal saline and attach that and go ahead and flush that through so that I can clear my patient's line of whatever they're receiving through that primary tube. So I'll flush that through, clearing that line.
Next, I'll go ahead and administer this medication. So I've already drawn it up. And unless I drop this and it becomes contaminated, I can just keep attaching syringes to it. So I'll attach this syringe, and I'll push this medication at the recommended rate for that medication, which you may need to look up at a drug book or a contact pharmacy to receive. So I'm pushing it at the recommended rate. I can then remove that syringe. And I'll need one more flush. So this flush is to make sure that the medication is out of that part of the tubing so that it is, A, administered at the correct rate, so I'll be pushing this three to five milliliters at the same rate that I pushed the medication. And, B, if I don't put normal saline right here and flush, the medication is going to come into contact with whatever is running through my primary line. And so if that is incompatible in any way, I wouldn't want them touching each other. So I go ahead and flush that through. And once I've completed that, I would return a new disinfectant cap if my facility follows that policy, make sure I unclamp or unkink my tubing and just restart my pump.
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