Myths of I.V. push administration

Author(s): Catherine Spader, RN

Learn the truth about safe administration.

Many myths abound about I.V. push medications. To dispel these myths and outline evidence-based standards of practice, American Nurse Today interviewed Elizabeth Campbell, MSN, RN, CRNI, past president of the Infusion Nurses Society (INS) New England Chapter and a clinical scholar at Massachusetts General Hospital in Boston.

Myth: Drawing medication from a prefilled syringe and transferring it into another syringe is safe practice.

Truth: The INS standards state that you shouldn’t transfer medication from one syringe to another. This practice can lead to a medication error or introduce bacteria into the syringe. In addition, a portion of the drug can be lost during transfer. Even a small loss can reduce the efficacy of a drug, especially with small-volume I.V. medications.

Myth: A 10-mL syringe is required to administer I.V. push medications via a central line or peripherally inserted central catheter (PICC).

Truth: Unfortunately, many nurses erroneously believe this to be true. To ensure proper dosing, use a syringe that’s the appropriate size for the administration of I.V. push medications via a venous access device. A 10-mL syringe is needed only to assess the patency of the device, not for administering medications. Educational programs must stress using the right-size syringe for the job.

Myth: It’s not necessary to label a syringe with medication that a nurse prepares if it will be administered right away.

Truth: The only time it’s acceptable not to label a syringe is if the medication is prepared at the bedside and administered right away. Otherwise, syringes should be labeled. That includes when preparing more than one medication at the bedside and when preparing any medication away from the bedside. The reason for these recommendations is that nurses often are interrupted during medication administration. If distracted even for a few moments, what was in the syringe and the dose may be forgotten. In addition, preparing more than one medication at the same time can lead to confusion about the contents of unlabeled syringes.

Myth: Diluting small-volume doses of medication, such as 0.5 mL, to ensure the patient gets the whole dose is a good idea.

Truth: This is false. Ready-to-administer medications come packaged the way they do for a reason. Diluting them can reduce their efficacy and introduce the risk of medication errors and contamination of sterile I.V. medications.

Myth: Using a 0.9% sodium chloride (saline) flush syringe to dilute I.V. push medications is acceptable.

Truth: Nurses may see using sa line flush syringes as an easy way to dilute and administer medications. However, the Food and Drug Administration has approved them only for flushing venous access devices. Nurses should be aware that not all brands of saline flush syringes are labeled “for flush only.” However, using any saline flush syringe for dilution is unsafe.

Myth: Diluting I.V. push medications will reduce patient discomfort and vein irritation in peripheral I.V.s.

Truth: The most important strategy nurses can use to avoid pain and complications is to ensure that the I.V. is patent, with a good blood return. You also should see no swelling or signs of vein irritation, such as redness and warmth. Administer the medication in the correct form and push it over the proper amount of time, as advised by the manufacturer. The I.V. catheter should be the appropriate size for the vessel. (See next Myth.)

Myth: Go big or go home: A large-bore catheter is ideal for a peripheral I.V.

Truth: Clinicians should use the smallest-bore catheter possible for the safe administration of medication and fluids. For example, using an 18-gauge catheter in a small hand vein can cause irritation. Pushing medications into veins that are already irritated can result in inflammation and lead to infiltration. Remember that the larger bore and the longer the catheter, the more irritation it may cause.

Here is a bonus myth/truth related to I.V. infusions.

Myth: Administering two antibiotics at the same time in different I.V. lines is okay.

Truth: Antibiotics should be given one at a time. Giving two or more at the same time can overload the kidneys and cause renal failure, especially with high doses of strong antibiotics, such as metronidazole and vancomycin.

Catherine Spader is an author and healthcare writer based in Littleton, Colorado.

For more information, see resources in A Matter of I.V. push drug safety.

Note: Since the publication of this article, pharmacy experts have noted that there is not evidence to support needing to administer I.V. antibiotics one at a time. One pharmacist notes: “I do not want to discourage the practice of giving two antibiotics at the same time because in several instances it may be ideal (sepsis, extended infusion). Separating antibiotics also does not help differentiate which antibiotic caused the reaction. For instance, if cefepime is I.V. pushed at 09:00 and vancomycin started at 09:30 but patient develops a rash at 10:00, you would not be able to definitively conclude which antibiotic caused the reaction.

“There is a lot of I.V. compatibility data supporting concomitant administration of antibiotics.

“Additionally, there are several other non-antibiotics (such as furosemide both oral or I.V/) that are eliminated through the kidney that we administer at the same time without worrying about ‘overloading the kidney’. When we get concerned about increased risk for nephrotoxicity with concomitant agents, it is not because they are administered at the exact same time but because patient is receiving both therapies.”

Fresenius-IV-Push

 

2 COMMENTS

  1. Valuable content. My question is do Central Lines , Port a Caths need a 10 cc syringe for medication admin to protect the integrity of the line. For example , benadryl 25 mg should be diluted in a 10 ml syringe w/ 10 ml of sterile saline and pushed slowly into the port ( 25 mg/ 60 sec ) ?

  2. Valuable content. My question is do Central Lines , Port a Caths need a 10 cc syringe for medication admin to protect the integrity of the line. For example , benadryl 25 mg should be diluted in a 10 ml syringe w/ 10 ml of sterile saline and pushed slowly into the port ( 25 mg/ 60 sec )

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