UTMB DEPARTMENT OF PHARMACY POLICY AND PROCEDURES Section Medication Use ADMINISTRATION OF MEDICATION BY IV PUSH

Transcription

1 Page 1 of 8 ADMINISTRATION OF MEDICATION BY IV PUSH AUDIENCE POLICY This document is directed to Registered Nurses (RNs), Licensed Vocational Nurses (LVN s), and physicians. The following delineates the policy for administering medication by IV push through an existing IV line or by direct venipuncture: Before administering a medication by IV push, the RN will identify the proper rate, maximum amount recommended, concentration, special precautions, and patient monitoring that is recommended. Medications that are vesicants, i.e., certain chemotherapeutic agents, should not be administered in a peripheral IV unless it is done by an RN who has been specifically trained for this procedure. LVNs may not administer IV push medications except to flush peripheral IV lines with saline and/or with heparin solution. IV Push policy for Pediatric Nursing: Drugs may be given by IV push in the Clinical Research Center as specified by approved research protocols. Drugs administered by IV push on the pediatric units in noncode situations will be limited as follows: * Routine IV push: 0.9% sodium chloride flush, heparin lock flush solution * Terminal patients requiring pain control by IV push: Morphine, meperidine * Non-code emergency (i.e., seizure, hypertensive crisis, anaphylactic shock, hypoglycemic crisis): Diazepam, dextrose, insulin, naloxone, diphenhydramine, epinephrine, furosemide, hydralazine Definitions used in this document: Name Definition Rapid IV Push Less than 30. Slow IV Push 3-5 (when rate information not found, slow IV push is indicated)

2 Page 2 of 8 Procedure Use the following procedure to administer an IV push: Step Action 1. Identify Patient using 2 patient identifiers. 2. Verify that the medication is appropriate to be given by IV push and that the patient is in the appropriate setting; verify rate of administration. 3. Read the label on the package/container of medication to ascertain the patient's name, drug, and dosage, and compare with the Patient's Medication Record. 4. Check the expiration date of the medication. Do not give drugs that are outdated, or have changed color or consistency. 5. Wash hands. 6. Cleanse the medication stopper with an alcohol swab and allow to dry. Draw up the amount of medication ordered. 7. Injection of medication: A. Through an existing IV line: 1. Prior to administration, verify the compatibility of the drug with the IV solution. KEY POINT: If at any point in the administration of the medication, signs of precipitation occur in the tubing/solution, stop injection of medication (do not continue the infusion), clamp the IV tubing, and call the physician immediately. 2. Check patency of the IV. 3. Cleanse injection port nearest catheter insertion site with an alcohol swab. Allow to dry. 4. For most medications, the primary line is kept open to further dilute the ordered medication. 5. Insert needle into port and inject medication as

3 Page 3 of 8 prescribed by the physician. 6. Withdraw syringe and dispose of appropriately. 7. Flush or open primary IV and return to ordered flow rate. B. By direct venipuncture: 1. Select suitable vein. 2. Apply tourniquet. 3. Cleanse the injection site. 4. Insert needle. When blood return is noted, remove tourniquet. 5. Inject medication at the ordered rate. 6. Place sterile gauze pad over injection site and remove needle. 7. Apply pressure over site with the sterile gauze. 8. Discard the syringe and needle in the appropriate container.

4 Page 4 of 8 Appendix I Medications Administered by IV Push NOTE: This policy is NOT all-inclusive. If a drug is not listed in this policy it does NOT mean that it cannot be given by IV push. Contact a Pharmacist or check a medical reference when in doubt. Levels: Describes the level of monitoring recommended for a specific medication to be delivered by IV push. * Monitoring requirements may be postponed in the event of a code and the arrival of the code team is pending. Level EKG BP RR I Restricted to ICU,ER, PACU, OR use only Continuous BP monitoring via arterial line; ICU, ER, PACU, OR use only Continuous SaO 2 ; ICU, ER, PACU, OR use only II Restricted to use with continuous EKG monitoring equipment and trained personnel present throughout administration Non-invasive BP monitoring at baseline, then at a frequency of every 15 x 4 during initiation, or for the expected duration of action of the medication RR monitoring at baseline, then at a frequency of every 15 x 4 during initiation, or for the expected duration of action of the medication III Non-monitored floor Non-invasive BP monitoring at baseline, after administration, then every hour for expected duration of action of the medication RR monitoring at baseline, after administration, then every hour for expected duration of action of the medication IV Non-monitored floor Non-monitored floor Non-monitored floor DRUG EKG BP RR Adenosine 1 II II II Alteplase 1 I II IV ADMINISTRATION 6-12 mg over mg over 1-2, remaining dose is given as an infusion COMMENTS Physician presence required.

5 Page 5 of 8 DRUG EKG BP RR Amobarbital 2 II II I ADMINISTRATION Max Rate: mg/min (NTE 1000 mg) Atenolol 1 II II IV 5 mg over 5 COMMENTS Dilute to convenient volume. * Atropine 1, 2 II II IV mg rapid IV push Butorphanol 1 IV III III mg rapid IV push Calcium chloride 2 II II IV Calcium gluconate 2 II II IV Chlordiazepoxide 1, 2 IV III III Max Rate: 100 mg (1.4mEq) over 1 minute Max Rate: 2 ml (10% soln) per minute (200 mg/ 2 ml mg over 1 minute Cisatracurium 3 I I I 0.1 mg/kg rapid IV push Dantrolene 1 III III I 1 mg/kg slow IV push Diazepam 2 IV III III 2-10 mg at a max rate of 2-5 mg/ min Diazoxide 1, 2 I II IV Digoxin III IV IV 1-3 mg/ kg over mg over 2-5 Digoxin Immune Fab II II IV Over 2-3 DHE 1 IV III IV 2mg over 2-3 Diltiazem 2 II II IV Edrophonium 1 II II IV Edrophonium 1 (Tensilon Test) IV IV IV 0.25 mg/ kg over 2 10 mg over mg over Requires 0.22 micron filter See next for Tensilon Test

6 Page 6 of 8 DRUG EKG BP RR Enalaprilat 1, 2, 3 IV II IV Epinephrine 3 I II II Etomidate I I IV Ibutilide II II IV Hydralazine III III IV Ketamine 1 II II II Labetolol 1, 2 II II IV Levothyroxine 1, 2 IV III IV * Lidocaine 1 II III IV ADMINISTRATION mg over 5 Anaphylaxis: 0.3-1mg over 5-15 Asystole: 1-5 mg 0.3 mcg/k over mcg/k over mg/ml over mg/ kg at a rate of 0.5 mg/ kg/ min 5 mg over 2 at 10 minute intervals up to 20 mg mcg over mg/ kg over 2-3 COMMENTS Refer to Moderate sedation policy. Use immediately after dilution with 5 ml of saline Lorazepam 1, 2 IV III III Max rate: 2 mg/ min Magnesium sulfate 1 II II II 1-2 grams over 5 Methylergonovine 1 IV III IV 0.2 mg over > 1 minute Metoprolol 1, 3 II II IV 5 mg over 2-5 Midazolam 1 IV III III Mivacurium 1 I I I mg over mg/ kg rapid IV push Nalbuphine 1 IV III III 20 mg over 1-2 Dilute to 10 cc in NS IM preferred due to risk of hypertension and CVA

7 Page 7 of 8 DRUG EKG BP RR Naloxone IV III III Neostigmine 1, 2 II II IV Pancuronium 1, 3 I I I Papaverine 2 IV II III Pentobarbital 2,3 I I I ADMINISTRATION mg slow IV push until symptoms resolve mg slow IV push mg/ kg over ml over mg at a rate of 50 mg/ min Phenobarbital 2 II II II Max rate: 60 mg/ min Procainamide III III IV 100 mg/ml over 2-4 Propranolol III III III 1 mg/minute Rocuronium 1,3 I I I Scopolamine 1 (for preop use) IV IV IV Secobarbital 2 IV IV IV Sodium bicarbonate 1 I I I 1.2 mg/kg rapid IV push mg over 2-3 Max rate: 50 mg over meq/ kg per dose COMMENTS Succinylcholine 1 I I I mg/ kg over Vasopressin I I I 40 units Vecuronium 2,3 I I I Verapamil 1 II II IV 0.1 mg/kg over mg over 2 For those drugs used for Moderate Sedation please refer to the Moderate Sedation Policy for appropriate administration.

8 Page 8 of 8 References 1. Lacy CF, Armstrong LL, Ingrim NB, Lance LL, eds. Drug Information Handbook. Lexi- Comp, Inc. Hudson, Ohio, Trissel LA, ed. Handbook on Injectable Drugs, 12 th ed. Washington, D.C.: American Society of Health-System Pharmacists, Inc Gora-harper ML, ed. The Injectable Drug Reference. 1 st ed. Princeton, New Jersey: Bioscientific Resources, Inc Brevital Package Insert. Eli Lilly and Company