# Administering IV medications SLOWLY



## rhan101277 (Sep 19, 2009)

I have a question about this, also with an example.  Say you have to give a morphine dose of 10mg.  Protocol states to push slowly over 3-5 minutes.  So you just sit in the back and push a little bit then wait and push more?  Seems like you would have to tape a syringe to their arm, unless they make little boluses or you have to waste most of a bag of it.  Most of ours come in the little glass medication containers with the rubber stoppers.  I am unsure of the concentration or volume. :unsure:


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## ki4mus (Sep 19, 2009)

rhan101277 said:


> I have a question about this, also with an example.  Say you have to give a morphine dose of 10mg.  Protocol states to push slowly over 3-5 minutes.  So you just sit in the back and push a little bit then wait and push more?  Seems like you would have to tape a syringe to their arm, unless they make little boluses or you have to waste most of a bag of it.  Most of ours come in the little glass medication containers with the rubber stoppers.  I am unsure of the concentration or volume. :unsure:



The vast majority of meds can be put in a 10cc syringe with sterile water or saline (10cc saline flush) taking up the rest of the volume that the drug its self does not, this makes it easier to give it over longer periods of time and also dilutes it so it doesn't sting near as bad going in.

the little glass containers with rubber stopers, are they  carpujects, or just standard ampules?


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## AZFF/EMT (Sep 19, 2009)

Like stated above I would normally draw up extra saline. I do npot like the carpujects at all. I would rather have all drugs in vials, much easier and more versitile in my opinion.


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## ResTech (Sep 19, 2009)

> Seems like you would have to tape a syringe to their arm, unless they make little boluses or you have to waste most of a bag of it.



What do you mean?


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## rhan101277 (Sep 19, 2009)

ki4mus said:


> The vast majority of meds can be put in a 10cc syringe with sterile water or saline (10cc saline flush) taking up the rest of the volume that the drug its self does not, this makes it easier to give it over longer periods of time and also dilutes it so it doesn't sting near as bad going in.
> 
> the little glass containers with rubber stopers, are they  carpujects, or just standard ampules?



Well I am confused on how to administer the drug over 3-5 minutes as 10mg is not much to push. 

Do you just draw of the med into the syringe, then change out needles.  Then administer drug through the drug port on the iv drip set?  If so then you have to clamp off fluid for 3-5 minutes and somehow have the syringe in a convenient area so you can push it little by little.

Maybe I am sleepy but can someone give me a step by step on administering this dose and how to do so in 3-5 minutes.  Giving the medication through the med port on a iv bag doesn't make since as you are going to run out the bag in 3-5 minutes.

P.S.

If this post seems silly I am sleepy.


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## usalsfyre (Sep 19, 2009)

Push a milligram or two, take the syringe off, watch for effect. Don't forget your roller clamp closed all the way down will prevent most backflow and you should be flushing you meds in on most patients.


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## ki4mus (Sep 19, 2009)

rhan101277 said:


> Well I am confused on how to administer the drug over 3-5 minutes as 10mg is not much to push.
> 
> Do you just draw of the med into the syringe, then change out needles.  Then administer drug through the drug port on the iv drip set?  If so then you have to clamp off fluid for 3-5 minutes and somehow have the syringe in a convenient area so you can push it little by little.
> 
> ...





depending on the med I just give a little bit, wait for a minute then give a little more...

and we don't change out needles, we use needleless drip sets..

but if it's something thatis given in 2-3minutes I just push the 10cc slowly.

and as for above, I don't like the carpujects either, we just push the meds out of them into a standard syringe..


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## DV_EMT (Sep 19, 2009)

yeah... 10cc's can be given slowly... if the drug is compatible with SW or NS just draw it up to make a total volume around 10cc's.. that was you can regulate it better. just remember that when you dilute it... it lowers the concentration (mg) per cc.... so if you want to give full strength... give the whole syringe...


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## rhan101277 (Sep 19, 2009)

The syringes we use have threaded ends and you screw on the needle.  Draw up the medication, then you are saying remove the needle and screw it on the threaded medication port on the iv line and just let it sit wherever.


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## DV_EMT (Sep 19, 2009)

It's called luer lock... And yeah... Do that... Just be sure to flush the line after


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## Ridryder911 (Sep 19, 2009)

Know what is scary, it is basics that is answering .........

R/r 911


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## Akulahawk (Sep 19, 2009)

Ridryder911 said:


> Know what is scary, it is basics that is answering .........
> 
> R/r 911


I'd be happier with basics answering correctly than with an MD/PhD answering incorrectly...


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## rhan101277 (Sep 19, 2009)

Ridryder911 said:


> Know what is scary, it is basics that is answering .........
> 
> R/r 911



Well I haven't been working any since April.  I have only spiked a couple of bags most paramedics I worked with wanted to do all of their stuff.  So I am learning about all the ports and such for the first time.  I hope to get more knowledge in clinicals and such.

I have never had to push medications through the iv tube either as basic's can't do it.


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## ki4mus (Sep 19, 2009)

I love how people complain about me posting on ALS discussions becouse I have "EMT-B/paramedic student".......but the things is, ya'll have no idea what I did before this....I've been in medicine longer than a lot of my medic school preceptors.....


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## Jon (Sep 20, 2009)

Ridryder911 said:


> Know what is scary, it is basics that is answering .........
> 
> R/r 911


Man... I wish we had a "Like" button like Facebook does... because this comment deserves a big 'ol Thumbs up.

As for the OP's question - if it needs to be given over a few minutes, you just slowly push it.... it isn't difficult.


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## 8jimi8 (Sep 20, 2009)

usalsfyre said:


> Push a milligram or two, take the syringe off, watch for effect. Don't forget your roller clamp closed all the way down will prevent most backflow and you should be flushing you meds in on most patients.



Almost.  You should flush the line after administering iv meds in all patients.



What you do first is check the compatability of your drug with the diluent and the fluids you have running.  Then you draw up the drug and diluent in a (most likely 10cc) syringe.  Clean off your dripset port with alcohol and then attach the syringe.  pinch off the tubing behind the syringe and push your drug slowly over time.  If your diluted drug is compatible with what is hanging in your bag, then you can release the pinched tubing to further dilute the drug that you are pushing (but don't push the drug while your tubing is unclamped because your drug may not go the direction that you want it to.)

If your drug and diluent are not compatible with the fluids you have running you must use a compatible solution to flush the line before letting the hanging fluid run back into the line.

They key item that the OP is not understanding is that small amounts of drugs are diluted before pushing them.  It is very hard to push a few CC's over 5 minutes.

*i almost didn't post this because if you don't understand this very basic concept you shouldn't even be considering touching an intravenous drug or a patient's iv line.*


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## Smash (Sep 20, 2009)

Akulahawk said:


> I'd be happier with basics answering correctly than with an MD/PhD answering incorrectly...



Amen. I don't care if the janitor answers, so long as it is correct.


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## DV_EMT (Sep 20, 2009)

Ridryder911 said:


> Know what is scary, it is basics that is answering .........
> 
> R/r 911




well...its pretty straightforward if you think about it logically...

Compatibility is my big thing (coming from the pharmacy side of me). There are a few drugs for instance that you can dilute with 1% lidocaine as opposed to NS or SW. but generally speaking... if you don't know, don't do.

So long as its compatible... thats the important thing!

I'd of course recommend getting micromedix... its a good program that can help you in the field (mobile version)


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## rescue99 (Sep 20, 2009)

DV_EMT said:


> well...its pretty straightforward if you think about it logically...
> 
> Compatibility is my big thing (coming from the pharmacy side of me). There are a few drugs for instance that you can dilute with 1% lidocaine as opposed to NS or SW. but generally speaking... if you don't know, don't do.
> 
> ...



MS is dispensed in say, 10mg/1cc. Dilute 1 mg MS with 9 cc sterile (from the IV bag for example) saline in a 10cc syringe thus, making the concentration easy to manage. Push as needed or as directed by medical control/protocol. 

I tape the vial and the capped syringe to the bag when so that it doesn't get lost and any waste can be witnessed by staff at the ER pretty quickly...no muss-no fuss. Loose narcs sink Medics  

Bacteriostatic water or sterile saline is generally what's on an ambulance and is what should be used for dilution. IM is another choice for delivering MS.


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## DV_EMT (Sep 20, 2009)

Ridryder911 said:


> Know what is scary, it is basics that is answering .........
> 
> R/r 911



lol... we're smarter than your average basic!


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## rhan101277 (Sep 20, 2009)

Well we haven't got into drug dilution yet.  We are just working on drawing up the drugs in the appropriate size syringe.  Also giving meds through ports to the dummy hands, or dummy IM, dummy sub Q.  I am sure I will think this thead is silly the deeper I get into this.

I realize pushing it slow is easy, but sometimes things get hectic and I wonder the best way to handle it.  If you have a stable patient then clearly its a simple issue, but critical patients are not.


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## Smash (Sep 21, 2009)

ki4mus said:


> I love how people complain about me posting on ALS discussions becouse I have "EMT-B/paramedic student".......but the things is, ya'll have no idea what I did before this....I've been in medicine longer than a lot of my medic school preceptors.....



Don't worry about it, a prerequisite for posting here is a fragile ego and blinkered vision.

Plenty of 'P's post stuff that is quite scarily wrong, and 'B's are quite clearly capable of posting correct or informative stuff, it's really pointless getting wound up about that sort of thing.


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## MSDeltaFlt (Sep 21, 2009)

rhan101277 said:


> *Well we haven't got into drug dilution yet. We are just working on drawing up the drugs in the appropriate size syringe*. Also giving meds through ports to the dummy hands, or dummy IM, dummy sub Q. I am sure I will think this thead is silly the deeper I get into this.
> 
> *I realize pushing it slow is easy, but sometimes things get hectic and I wonder the best way to handle it. If you have a stable patient then clearly its a simple issue, but critical patients are not*.


 
rhan,

For an opioite like morphine, a 10cc syringe is the most appropriate syringe because you will need to also draw up enough flush in the same syringe to make it a 1:1 concentration which makes morphine more manageable.

Yes sometimes things do get hectic in the back.  Because when you're "b*lls to the wall" back there, odds are definitely in your favor that you'll miss something very important.  That's when you'll need to slow down and make d*mn sure you're doing it right.

Hope this helps, dude.


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## MasterIntubator (Sep 21, 2009)

For your original question, 3-5 minutes seems like a long time to push Morphine... and it is. Maybe 2 minutes would be more realistic.  I know I give it a bit faster than that, and 9 times out of 10... I would only be giving 3-5mg the first round, then reassess the pain and continue on.
But you gotta follow your protocols.

Now, to expand a few things many medics have not been taught, is the priming volume in your IV sets/PRN adaptors/extention sets.  Most companies print the priming volume on the sets, this is IMPORTANT.  
For instance... my standard 72 inch IV set has a priming volume of 17ml.  The PRN adaptor at the end of that is an additional 3ml - with an injection port in the middle of that PRN adaptor. ( my sets also have a backflow preventer, no need to pinch lines anymore ).... again... know your equipement inside and out.
If your set does not say it, measure it out.  Simple enough to do.

This is where it makes you think.... So you need to give 10MG morphine, in my world, it is a carpuject 10mg/ml tube.  So that 1ml will be my volume.
If I inject that into the closet port to the pt, right in the middle of my PRN adaptor with a prime of 3ml.... it would make sense that the port requires 1.5ml of fluid before the pt gets the dose.

( read that again if you need to )

So you S L O W L Y push that 10mg into the line.... guess where it is? Still in the line.  The 1ml (10mg)  was not enough to make it to the pt.  You just spent 3-5 minutes pushing that MSO4 in the line and the pt never got it yet.  Then you open the line to flush it in... ya know what?  They just got that 10mg whopping fast.... head rush.. nausea.. vomiting... you know the drill. 

You may as well just inject it quickly into the line, then drip it in slowly.  Almost always I get a small little air bubble that was trapped in the first time use injection port.... so I use that as a guage of where my drug is in the line, and follow that bubble adjusting my drip rate to make sure it goes slow. ( little bubbles won't hurt anyone, the body does great absorbing these, just don't daisy chain 100 bubbles in.. duuhhh  ) 

The other option is to inject it slowly with the line flowing, just make sure it does not back flow into your syringe, then that can mess up your concentration increments in the syringe.

You can always request a syringe pump, then you can get some hands free assistance... and you can spend that 3-5 minutes actually doing work. 
Honestly, I have never seen anyone push MSO4 over 3-5 minutes.... its usually somewhere around 30 seconds, or they just break the dose up.. give 5... check them out... give another 5.  Never have needed to diluted it either.

5mg will give great relief for a fracture pt who has never had morphine before.... on the other hand, the cancer pt with a tolerance may need 30-40mg at once.

Talk to your pt... "have you had MSO4 before?"  If so... how was it? 

good luck!


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## ResTech (Sep 21, 2009)

MasterIntubator... great post! thanks for taking time to explain it like you did. It was very helpful.


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## Akulahawk (Sep 21, 2009)

There's a lot to this, but MasterIntubator hit one of those issues... the volume needed to get the drug into the patient's bloodstream where it is needed. 
Another way to do it is to introduce the amount of drug you want into the line and slowly flush the line with the amount of fluid to get the drug into the patient. This requires that you know how much fluid it takes to flush from the port (including the volume in the port)...

It's a little late for me, so I hope this makes sense...


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