Microsoft word - iv push policy updated final may 201

The University of Kansas Hospital
Corporate Policy Manual
Volume: Patient Care
Section: Medication Management
POLICY Title: Administration of IV Push Medications on non-critical care units
Signature __________________________________________________________________ Tammy Peterman / Executive Vice-President, Chief Operating Officer,
Formulation:___4/2009______ Revised:_____05/2011______ Reviewed:__________________
Date
Contact Person Responsible for Policy Updates: Joann Lacy, Pharmacy Clinical Coordinator
WORKFORCE GROUP TO BE TRAINED ON THIS POLICY


Purpose:
To establish guidelines for the administration of IV push medications on non-critical care units. Only registered nurses that have successfully validated basic IV competency can administer IV push medications on non-critical care units. Only designated intravenous medications that have been approved by the Pharmacy and Therapeutics Committee may be administered by IV push on non-critical care units. These guidelines are to be used with adult patients (≥17 yrs.) only. The administration rates are guidelines and may be changed by the physician to meet the individual needs of the patient. The nurse should consult with the physician or clinical pharmacist if there is a question about the safe administration of the drug. An IV medication reference must be readily available on each nursing unit. Emergent treatment situations are not restricted by the guidelines of this policy. This policy does not include clotting or coagulation factors that may be pushed according to manufacturer recommendations. This policy does not include chemotherapy medications that may be pushed according to manufacturer recommendations by a chemotherapy competency validated registered nurse. RATE OF ADMINISTRATION
DRUG APPROVED IV PUSH RANGE
DILUTION
COMMENTS/MONITORING
Atropine
Aztreonam (Azactam®)
Bumetanide (Bumex® )
Butorphanol (Stadol®)
Cefazolin (Ancef®)
Cefotaxime (Claforan®)
Cefoxitin (Mefoxin®)
Each 1 gram diluted with at least 10 mL of normal saline. Vials and Ceftazidime (Fortaz®)
syringes must be vented after dilution and before administration. Ceftriaxone (Rocephin®)
Cefuroxime (Zinacef®)
Dexamethasone (Decadron®)
Dextrose 50% (50gm/100mL)
Undiluted. Not compatible with
Diazepam (Valium®)
Diphenhydramine (Benadryl®)
Administer slower in non-emergent situations. Droperidol (Inapsine®) – SEE
symptoms. Doses > 2.5mg should be administered via PB. Each dose over 1 minute. Intravenous route is preferred for patient with chronic renal failure Epoetin Alpha (Epogen®)
on hemodialysis. Subcutaneous administration is preferred in other populations. Esomeprazole (Nexium®)
Estrogens, conjugated (Premarin®)
mL sterile diluent in package. Do not shake. Famotidine (Pepcid®)
Fentanyl
Furosemide (Lasix®)
Glycopyrrolate (Robinul®)
Granisetron (Kytril)
Haloperidol lactate (Haldol®)
RATE OF ADMINISTRATION
DRUG APPROVED IV PUSH RANGE
DILUTION
COMMENTS/MONITORING
Hydrocortisone sodium succinate
(Solu-Cortef®)
Hydromorphone (Dilaudid®)
Through saline-lock IV: Dilute to total of 5mL with NS, D5W, or SW Insulin, Human Regular
Ketorolac (Toradol®)
Dilute 500 mcg vial with 5 mL of preservative-free normal saline. Use Levothyroxine sodium (Synthroid®)
Lorazepam (Ativan®)
Meperidine (Demerol®)
Through saline-lock IV: Dilute to total of 5mL with NS, D5W, or SW Meropenem (Merrem®)
Mesna (Mesnex®)
Methylprednisolone (Solu-Medrol®)
Methylthionine Chloride (Methylene
Each 10mg or fraction thereof over 2 minutes. Metoclopramide (Reglan®)
Doses greater than 10 mg should be administered via PB Morphine
Through saline-lock IV: Dilute to total of 5mL with NS, D5W, or SW Naloxone (Narcan®)
- Emergency situations:
Respiratory arrest, apnea
- Non-emergency situations:
Respiratory depression
Octreotide (Sandostatin®)
Preferred rate of infusion: Single dose over 2-3 minutes Ondansetron (Zofran®)
Paricalcitol (Zemplar®)
Phenobarbital
Phytonadione (Vitamin K)
1 mg/minute maximum rate—
IV NOT ROUTE OF CHOICE
therefore, 10mg adult dose must
be over 10 minutes.
RATE OF ADMINISTRATION
DRUG APPROVED IV PUSH RANGE
DILUTION
COMMENTS/MONITORING
CAUTION: Risk of anaphylaxis
Prochlorperazine (Compazine®)
Pyridoxine (Vitamin B6)
Each 100mg or fraction thereof over 5 minutes. For 100mg or Thiamine (Vitamin B1)
larger doses, equal distribution over an extended time as an infusion is preferred. Warfarin (Coumadin)
RESTRICTED IV PUSH MEDICATIONS WITH SPECIAL PRECAUTIONS

The following medications may also be pushed when necessary; however, these medications have specific guidelines for monitoring parameters and/or
competency requirements. The patient will be located in an area that is able to provide appropriate monitoring. The pharmacist will ensure that
the patient’s location coincides with any area restrictions as outlined in the RESTRICTED INTRAVENOUS MEDICATIONS list found on
Formweb before dispensing the medication. It is the nurse’s responsibility to ensure appropriate administration and monitoring requirements
are met (i.e. cardiac monitor if medication is restricted to telemetry level of care or higher).
*Refer to RESTRICTED INTRAVENOUS MEDICATIONS document located on FormWeb for Location Restrictions and
Approved Areas for Administration

RATE OF ADMINISTRATION
APPROVED IV PUSH
DILUTION
COMMENTS/MONITORING
Normally loading dose administered over 1 hour
followed by 1 to 1.25 gram/hour infusion.
*Aminocaproic acid (Amicar)
Undiluted loading dose can be given over 1 minute
in ICU patients experiencing severe postoperative
bleeding. Monitor neurologic status and vital signs.
Watch for hypotension, bradycardia, arrhythmias.
Begin infusion at a dose of 3 mcg/kg/min at initial signs of recovery from bolus dose. Monitor heart rate, *Cisatracurium (Nimbex )
blood pressure, and respiratory rate. Patient must be
ventilated and sedated.
Cosyntropin (Cortrosyn )
Continuous observation for at least 30 minutes. Monitor BP every 5 minutes for 30 minutes. Small doses (1-2 mcg) may be given over 1 minute
larger doses can be given over 5-10 minutes in ICU
*Desmopressin Acetate
patients experiencing severe postoperative bleeding.
Monitor vital signs. Watch for hypotension,
tachycardia and flushing.
Larger doses are normally infused over 15 to 30 minutes as IV infusion and may be administered via Piggyback to non-ICU patients. Single dose over a minimum of 5 minutes. Monitor Digoxin (Lanoxin )
apical pulse and BP before and after dose. Single dose over 2 minutes. PATIENT MUST BE ON
*Diltiazem (Cardizem )
A CARDIAC MONITOR DURING
ADMINISTRATION.
Each 2.5 mg over 1-2 minutes. Monitor for
extrapyramidal symptoms.
Droperidol (Inapsine®)
For all doses in patients with QTc > 450 msec,
continuous ECG monitoring required for minimum of Doses outside of OR/PACU AND greater than
1.25mg require 12-lead ECG prior to administration to
determine if prolonged QT interval exists. In addition patient must undergo continuous ECG monitoring for minimum of 2 hours ater last dose. Single dose over 5 minutes. Monitor vital signs every
Enalaprilat (Vasotec )
15 minutes for 1 hour following each dose. May
have significant drop in BP following the first dose.
Fentanyl (Sublimaze )
If given for procedures, this drug requires Level II
Through saline-lock IV: Dilute to total of 5mL with moderate sedation competency to administer.
RATE OF ADMINISTRATION
APPROVED IV PUSH
DILUTION
COMMENTS/MONITORING
Each 0.2 mg dose over 15 seconds. Monitor BP, HR,
RR. ECG and pulse oximetry recommended. If
Flumazenil (Romazicon )
given for procedures, this drug requires Level II
moderate sedation competency to administer.
Single dose given over 1 minute. Check BP every 5
Hydralazine (Apresoline®)
minutes until stabilized at the desired level. Withdraw drug gradually to avoid rebound hypertension. Each 20mg or fraction thereof over at least 2 minutes. Labetalol (Normodyne®,
Keep patient supine for 3 hours after infusion.
Trandate )
Monitor BP before dose and every 5 minutes for 15
minutes after each dose.
Each dose should be further Singe dose over 15-20 seconds. Dose adjustment may diluted with 10 mL NS for a be necessary for patients with renal impairment. *Lepirudin (Refludan®)
Baseline aPTT should be obtained prior to initiating therapy. Each 5mg must be pushed over 1-2 minutes. May repeat 5mg boluses every 2 minutes up to 15mg. *Metoprolol (Lopressor®)
PATIENT MUST BE ON A CARDIAC MONITOR
DURING ADMINISTRATION.
Midazolam (Versed®)
Each dose titrated slowly over at least 2 minutes. This
drug requires Level II moderate sedation
competency to administer.
Neostigmine (Prostigmin)
Each 0.5mg or fraction there of over 1 minute. PHYSICIAN MUST BE
Monitor pulse rate. Pulse rate should be at least 80 beats/minute. NURSE MAY ADMINISTER WITH
PHYSICIAN PRESENT AT BEDSIDE or IV
NEOSTIGMINE MAY BE ADMINSTERED BY
PHYSICIAN. Atropine 1mg IV and Epinephrine
1mg IV should be available at bedside. Nurse may
administer IM or SQ with out physician present Give only through a large-bore vein (preferably via
a central venous site); Use of hand or wrist veins
strongly discouraged! Check patency of site before
administration. Inspect site around catheter tip and Promethazine (Phenergan®)
extremity for swelling, blanching, bleb formation, Administer via a running
stretched and firm skin or coolness. Ask patient to IV
report any burning or discomfort during infusion. If extravasation suspected, stop infusion immediately and notify physician. 50 mg or fraction thereof over 10 minutes, not exceeding 5mg/min. More rapid infusion rates may be *Protamine
requested in ICU patients experiencing severe postoperative bleeding. Monitor vital signs. Watch for hypotension, bradycardia pulmonary hypertension, dyspnea, flushing and hypersensitivity reactions. Administered by rapid direct infusion. Monitor blood *Vecuronium (Norcuron®)
pressure and heart rate. Patient must be ventilated
and sedated.

Source: http://www2.kumc.edu/pharmacy/guidelines/IV%20Push%20List.pdf