IV push medications. I get asked a lot to do a video on how to do IV push safely.
So we're going to tackle that right after this. Welcome back my name is Tammy
and this is Nurseminder and on this channel we do everything nursing so if
you're new here consider subscribing below so that you get the next video
when it's released. So IV push medications requires several elements of
Nursing put into one task. Anytime we get a medication order we need to be looking
at our medication rights, and so we're not going to cover those today we're
really going to focus on the process that goes into IV push after the
medication ,,, in medication rights are done. Next we want to determine if it's in my
scope of practice. To understand that we need our parental manual. All right so
we're working with our patient today and we receive an order for ondansetron
IV push. The first place we want to look to see if we can give it IV push is the
parental manual. Routes of administration, IV, direct IV is the same as IV push, and
it says yes but there's this number one beside it - that means I need to do a
little bit more reading to find out if I can give it. So as I carry on in my
parental manual I see the required education, equipment, and monitoring.
Number one says a health care professional must have a specialized
clinical competency to administer direct IV. A specialized clinical competency
means that you have received additional education in the form of maybe an online
module, or in-class training and have had some sort of assessment evaluation of it.
That may include a written exam, a return demonstration with an educator on a
mannequin, and/or practical application with a real patient under the
supervision of somebody else who can sign you off . And once you've been deemed
competent then you are allowed to do this independently. The next thing we
want to find is the usual dosing, and here we are at the adults section.
In this, so prevention of post-operative nausea and vomiting, we can give IM direct
IV or infusion four milligrams as a single dose before induction of
anesthesia or post operatively. Treatment of post-op nausea and vomiting direct IV
four milligrams as a single dose. So this fits our order - four milligrams IV push
now times one dose. What I want to go to next is the actual instructions for a
direct IV. For this medication it says it can be administered undiluted at a two
milligram per ml concentration over two to five minutes. Now if I've never given
ondansetron before I need to know where - what it's like - where am I gonna find it
what does it look like. That information is also in here as well under product
description. It's available as a 2 milligram per ml injection in a vial or
ampule, so I now know what I'm looking for, and it doesn't have to be in a
fridge it can be at room temperature so it's probably just sitting on the
counter somewhere so I'm gonna take a look for that. All right so I have my
ondansetron 2 milligram per ml l and I found that it's in ampule. Now this vial
has got medication up here in the tip of the ampule and I don't want that, so I'm
going to simply give it a quick tip and you see the air has filled the ampule
and the medication is now all here. Gathering my supplies; because this is an
ampule and when I break off here there's likely to be shards of glass that we
can't see, I need a blunt end needle - a blunt fill needle. Yeah I'm gonna use a
three ml syringe because I'm drawing up two mls; my orders for 4 milligrams. I'm
gonna go ahead and get my needle ready
Now to open up the ampule sometimes we end up cutting ourselves, so if you work
in a facility that has the plastic sheath that goes on here - awesome - if not I tend
to use an alcohol swab to cover around here. I'm going to push with my thumb
away from me such that it opens like that. Dscard your sharps and now I can
grab my needle, insert and I can withdraw. In fact I can turn this right
upside down you see the fluid is not coming out and I can withdraw my 2 mls.
Now you want to label your vial before you go into the patient's room. I've got
my ondansetron 2 milligrams for mls; there's no confusing. I like to put it on
the hubcap so that when I remove it I'm not losing sight of my mls here. So at
the patient's bedside, in this scenario, we do have normal saline infusing. So with my
saline infusion running, I'm simply going to clean off my port closest to my
patient for at least 15 seconds.
and I don't have to stop the Saline here I'm simply going to let that run. I'm now
going to attach my ondansetron and I like to turn it so that I can see all of
these lines. I know I have to go at least two minutes and I can go up to five
so my tendency - oops there's a little bit of air in there - let me get rid of that first. My
tendency is to give a tenth so like I'll take a push up to one line and I'll take
ten seconds for each subsequent line. Then the next 10 seconds I'll push up to
this line. Make this easier for you to see. 20 seconds so I'm going to push in a
tenth of an ml and then I'm gonna wait till 30 seconds I'm gonna push in the
next ml or 1/10 of ml, wait till 40 seconds and push in the next so you can
see that it's gonna take me - so we're already at 30 seconds now total
duration and then pushing in there we go
and you just continue on this until the two minutes or until the vial is empty
actually which will take you just over two minutes. Now if my patient just has a
saline lock we're gonna clean this again for 15 seconds and for the interest of
this video I'm going to fast forward this part I have a saline flush here of
which I'm going to then flush to make sure my IV is patent. I only need 3 mils
to do this part so I'm going to push in positive pressure. It shouldn't be
resisting. There's my 3 ml s. I'm gonna discard this one and now that my line is
flushed and patent, I can go ahead and give my medication.
Again I need to clean for 15 seconds; for the interest we will we will
fast-forward that part ;attach my medication, get my watch ready, and I will
do the same method. I'm gonna turn it so I can see. I'm gonna push at 15 seconds
up one tenth of a ml and wait for the next. Push one tenth of a ml and wait
until it's 30 seconds. I'm gonna push in the next tenth of a ml and pause and
when we get to 40 seconds I'm going to push in the next ten - so it actually
feels like I'm doing something a little bit each step on the journey but my
patients getting their medication in a safe manner.
Okay and we'll assume that this is all done now. Again we need to clean the hub,
every time we access we need to clean the hub, and because it's still full of
medication, I need to then instill three cc's of flush but going at the same rate.
So I'm only going to just push in a little bit
because that's full of medication currently I don't want to go too fast.
Just push and pause, push and pause, and once I feel I've got the medication
through there I can finish off my last couple cc's of saline flush. Push and
pause one more and I think that's going to cover it and now I can just infuse
the last of that three cc's. Disconnect,
and you're done! So today we've looked at several elements that are involved in
giving IV push medications and we've talked about how to do it with an
infusion and without an infusion. I hope this has been helpful. If you have any
comments questions please make sure you comment below, like, hit the like button
and subscribe so that you get the next video when it's released. Until next time
make it a great day