Intravenous (IV) push is a method of medication administration where a concentrated dose of medication is injected directly into a vein over a short period of time, typically seconds to a few minutes. This technique is often used when a rapid therapeutic effect is necessary, such as in emergency situations or when bypassing the digestive system is required for immediate action. Administering an IV push into a running primary fluid line allows the medication to quickly enter the patient’s bloodstream and circulate throughout the body. Because this method delivers the full dose immediately, precision and strict adherence to safety protocols are important to prevent complications like adverse drug reactions or tissue damage.
Essential Safety Checks and Preparation
Before any medication is prepared or administered, a thorough safety verification process must take place to minimize the risk of error. This process begins with confirming the “Five Rights” of medication administration. The medication should be checked against the physician’s order at least three times—when retrieving it from storage, when preparing the dose, and immediately before administering it at the bedside.
The Five Rights
- Right patient
- Right medication
- Right dose
- Right route
- Right time
A fundamental safety check involves verifying the integrity of the IV access site, looking for signs of infiltration (fluid leaking into surrounding tissue) or phlebitis (inflammation of the vein). The IV site must be patent, or open, to ensure the medication is delivered directly into the vein and not into the soft tissue, which could cause significant harm. Assessing the patient for known allergies is mandatory before the medication is drawn up or injected.
A paramount safety step specific to injecting into a running line is confirming Drug and Fluid Compatibility, often referred to as Y-site compatibility. The concentrated push medication must not interact negatively with the primary IV fluid running through the line. Incompatibilities can be physical, such as forming visible precipitates, cloudiness, or color change, or chemical, which involves an unseen degradation of the drug’s effectiveness.
To verify compatibility, a reliable drug reference guide must be consulted. If the push medication is found to be incompatible with the running primary fluid, the administration procedure must be modified. This modification involves temporarily stopping the primary infusion and flushing the line with a compatible solution like normal saline. Once all safety checks are complete, necessary supplies are gathered, including the medication syringe, pre-filled normal saline flush syringes, alcohol swabs, and gloves.
Step-by-Step Administration Technique
The physical act of administering the IV push requires a precise, sequential technique to maintain sterility and ensure the medication reaches the patient safely. The procedure begins with performing hand hygiene and donning clean gloves. The correct injection port, which is the access point on the IV tubing closest to the patient, must be identified for the injection.
The injection port, or hub, must be thoroughly disinfected, a process often called “scrub the hub.” This involves vigorously scrubbing the surface of the port with an alcohol swab for a minimum of 15 seconds, followed by allowing it to air dry completely. This mechanical friction and chemical action significantly reduce the risk of introducing bacteria into the bloodstream.
Before connecting the syringe, the primary infusion pump must be paused or the tubing must be temporarily clamped just above the injection port. This step is performed to prevent the pressure from the push medication from forcing the primary IV fluid backward up the tubing, which could delay the medication’s delivery or dilute it excessively. Once the pump is paused, the medication syringe can be securely attached to the disinfected injection port.
The medication is then administered using the push technique, where the drug is injected at a specific, controlled rate, which is typically over one to five minutes, depending on the drug. The administration rate is determined by the drug manufacturer’s recommendations or hospital protocol to prevent adverse effects like “speed shock,” which can occur when a drug is injected too quickly. The clinician should utilize a watch with a second hand to accurately time the administration, often employing a “push-pause” method, where small amounts are injected, followed by a brief pause.
After the entire dose of medication has been pushed, the line must be cleared to ensure no residual drug remains in the tubing. This is achieved by flushing the line with a pre-filled syringe of normal saline. The saline flush, typically 3 to 10 milliliters, should be pushed at the exact same rate as the medication was administered to avoid a sudden bolus of the remaining drug.
Following the saline flush, the syringe is removed, and the primary infusion pump is immediately restarted at its prescribed rate. Restarting the pump ensures the patient continues to receive their maintenance IV fluids or medications without interruption. The injection port should be disinfected again after the flush, if facility policy requires a new protective cap.
Managing Infusion Compatibility and Post-Procedure Monitoring
For IV access devices that are not connected to a continuous infusion, such as an intermittent venous access device, the SASH (Saline-Administer-Saline-Heparin) or SAS (Saline-Administer-Saline) technique is used. This method involves flushing the line with saline before and after the medication. The technique for a running line is simpler because the continuous fluid flow maintains patency.
If signs of incompatibility appear during or immediately after the push, such as cloudiness, crystallization, or precipitation within the tubing, the procedure must be stopped immediately. The line should be clamped, and the healthcare provider should be notified, as this reaction means the drug’s integrity is compromised and could pose a danger to the patient. If a physical incompatibility is observed, the entire IV line segment where the reaction occurred may need to be replaced.
Immediately following the IV push, patient monitoring is a necessary safety measure, especially because the rapid delivery of medication can cause swift physiological changes. The clinician must remain with the patient for several minutes to observe for any adverse reactions, such as changes in heart rate, blood pressure, or signs of an allergic response. Finally, the entire procedure, including the medication given, the dose, the time, the route, and the patient’s response, must be accurately documented in the medical record.