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General Information Regarding Administering

IV Push Medications
IV Push (Bolus) means one is administering a medication from a syringe directly into an ongoing
intravenous infusion or saline lock. Many drugs are irritating to the vein; therefore you should always
refer to a package insert pharmacist or drug reference !ook for sufficient type and amount of diluent.
Most medications are given slowly (at least over "#$ minutes). %dministering IV Push medication too
fast will increase the concentration in the plasma. &hese levels may reach to'ic proportions resulting
in shock or cardio#pulmonary arrest.
Before administering any medications the nurse is responsi!le for fully understanding the medication
e'pected therapeutic effects recommended dose and route potential side effects as well as antidote
availa!ility. Be aware that reactions can occur more (uickly with IV push medications. If reactions
occur contact the physician immediately.
If IV Infusions are already in progress the nurse must ensure drug compati!ilities. It is always wise
to flush the IV with normal saline !efore and after drug administration.
NURSING ALER! )nusual dosages or unfamiliar drugs should always !e confirmed with the
physician and*or pharmacist prior to administration. &he nurse is ultimately accounta!le for the drug
that he or she administers.
Indications for IV Push Medication!
+hen a (uick response to the medication is re(uired
+hen loading doses of medications are necessary
&o reduce patient discomfort !y limiting the num!er of IM in,ections
&o avoid incompati!ility pro!lems that may occur when delivering several
medications
&o deliver medications to patients una!le to take them !y mouth or IM
Patient"s #i$e Rights!
Right %rug Right %ose
Right Patient Right Route
Right ime
Refer to LSUHCS Nursing Policy I40, Administering Medication y I! Pus", for current nursing #rocedure$ %0&'0()
Medications to &e Administered Intra$enous 'IV( Push
)umetanide ')ume*(
+lass! -iuretic
Indications! .dema in /01 hepatic or renal disease
%osage,Administration!
Adults!
)sual parenteral dose is 2.3#".2mg. 4ot to e'ceed "2 mg*day
Pediatrics!
2." 5 2.$ mg*kg*dose every 6#"$ hours. Ma'imum dose of 2.7 mg*kg*$8 hours
By IV in,ection it should !e given slowly o$er one to two minutes. % second or third dose may !e
given at intervals of $#7 hours
9apid administration may !e associated with ototo'icity (hearing loss)
0igh doses and prolonged therapy may result in profound diuresis (which may result in fluid and
electrolyte distur!ances#hypotension arrhythmias)
Ad$erse Reactions!! Muscle cramps di::iness hypotension
+ontraindications! ;evere .lectrolyte depletion %nuria 0epatic coma < 4eonates
+imetidine 'agamet(
+lass! 0istamine=0$ 9eceptor antagonist
Indications! >astric and duodenal ulcers
%osage,Administration!
Adults!
822#"?22mg daily
Pediatrics!
$2#82 mg*kg*$8 hours divided dose every ? hours. -ilute "3mg*cc- Administer o$er ./
minutes-
%dminister slowly !y direct IV in,ection intermittent or continuous intravenous infusion.
+hen given !y direct intravenous in,ection a 722 mg dose should !e diluted to $2 ml with 2.@A
sodium chloride de'trose 3A in water de'trose "2A in water or lactated ringers and administer
o$er at least / minutes.
Ad$erse Reactions!! 0eadaches -iarrhea
9apid administration of /imetidine as an IV !olus has !een associated with cardiac arrhythmias and
hypotension.
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+ontraindications! Dnown sensitivity to the drug.
%e*amethasone '%ecadron(
+lass! ;ynthetic /orticosteroid
Indications! %drenal insufficiencies severe allergic and inflammatory conditions cere!ral edema
croup
%osage,Administration!
Adults!
)sual IM or IV dose is 2.3#@mg*day as a single dose or divided every ? hours. -oses range up
to $8mg*day (higher doses may !e re(uired dependent upon the patientEs condition and
response).
Pediatrics!
%nti#inflammatory responseF 2.27#2."3mg*kg*$8 hours
/roupF 2.?mg*kg*dose (one time dose).
&he 8 mg*ml preparation may !e given !y IV IM Intra#articular intrasynovial or intralesional.
%e*amethasone 01 mg,ml may &e only administered IV-
IV de'amethasone is administered IV Push o$er se$eral minutes or !y continuous or
intermittent infusion
Ad$erse Reactions! 1luid retention /01 muscle weakness
+ontraindications! ;ystemic fungal infections ;ulfite sensitivity (in,ecta!le forms of
de'amethasone contain sulfites)
%e*trose 0/2 or %e*trose /32
Indications! 0ypoglycemia
%osage,Administration! .'cept in the emergency treatment of severe hypoglycemia higher
concentrations of de'trose (e.g. $2A and higher) should !e administered via central veins and only
after appropriate dilution.
+hen used for the emergency treatment of hypoglycemia hypertonic de'trose in,ections may !e
administered slowly via a peripheral vein.
1or the treatment of hypoglycemia resulting from insulin e'cess or other causes in adults and
children the usual dose is $2#32 ml of 32A de'trose in,ection administered slowly (e.g. 7ml*minute)
!y IV in,ection.
Ad$erse Reactions! If hypertonic de'trose solutions are infused too rapidly local pain and vein
irritation may occur.
+ontraindications! 0yperglycemia dia!etic coma intracranial or intraspinal hemorrhage delirium
tremens.
G-e'trose $3A in water (-$3+) is o!tained !y mi'ing e(ual amounts of de'trose 32A in water and
sterile water ("F" solution).
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%ia4e5am 'Valium(
+lass! %ntian'iety %gent
Indications! ;keletal muscle spasms management of an'iety disorders acute management of
convulsive disorders.
%osage,Administration!
Adults!
9ecommended dosage rangeF $#$2mg (IV doses are $ to 3 mg IV every 7#8 hours !ut higher
doses may !e re(uired in some cases).
Pediatrics!
2." 5 2.7 mg*kg*every $#8 hours. Ma'imum dose of 2.? mg*kg within 6 hours. -H 4H&
.I/..- an infusion rate of ".3 mg*minute or 2.$3 mg*kg*dose.
+hen given IV dia:epam should !e in,ected at rates not e*ceeding / mg,min to prevent apnea
venous throm!osis phle!itis and hypotension.
%lthough cessation of sei:ure activity is usually rapid significant num!ers of patients sei:e again due
to the short half#life of dia:epam.
-o not administer through small veins such as those on the dorsum of the hand or wrist.
-o not dilute with other solutions or drugs in the syringe.
Ad$erse Reactions! -rowsiness fatigue ata'ia < respiratory depression.
Parado'ical reactions include an'iety and hallucinations.
+ontraindications! %cute narrow angle glaucoma or untreated open#angle glaucoma -epressive
neurosis psychotic reactions.
%i5henhydramine ')enadryl(
+lass! %ntihistamine
Indications! %llergic and anaphylactic reactions
%osage,Administration!
Adults!
"2 to 32 mg every $ to 6 hours (ma'imum daily dose is 822mg)
Pediatrics!
3mg*kg*$8 hours in divided doses every ? hours for a ma'imum of 722 mg*$8 hours.
May !e administered !y deep IM IV in,ection 'o$er 67/ minutes( and continuous or intermittent IV
infusion.
Ad$erse Reactions! ;edation di::iness ata'ia epigastric distress thickening of !ronchial
secretions.
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+ontraindications! 4ew!orns or premature infants known sensitivity*hypersensitivity to the drug.
%ro5eridol 'Ina5sine(
+lass! %ntiemetic
Indications! 4ausea and Vomiting
%osage,Administration!
Adults!
$.3 5 "2 mg IM initially then ".3 5 $.3 mg slow IV push (usually for maintenance)
Pediatrics!
($ 5 "$ years of age) " 5 ".3 mg*$2 5 $3 l!s.
Ad$erse Reactions! 0ypotension dysphoria drowsiness restlessness an'iety.
+ontraindications! Dnown hypersensitivity.
#amotidine 'Pe5cid(
+lass! 0istamine (0$) receptor antagonist
Indications! -uodenal and gastric ulcers
%osage,Administration!
Adults!
$2 mg every "$ hours or 82 mg every day.
Pediatrics!
9arely given.
%dministered !y slow IV in,ection or infusion.
1or in,ection $2 mg should !e diluted to 3 to "2 ml with 2.@A sodium chloride and in,ected no faster
than .3 mg,minute 'gi$en o$er at least 0 minutes(-
1or Infusion $2 mg should !e diluted in "22 ml of de'trose 3A in water or other compati!le diluent to
yield a 2.$ mg*ml solution. &he solution should !e infused o$er ./ to 63 minutes-
Ad$erse Reactions!! 1ever arrhythmias muscle pain and cramps grand mal sei:ures
!ronchospasm.
+ontraindications! Dnown hypersensitivity.
#luma4enil 'Roma4icon(
+lass! Ben:odia:epine receptor antagonist
Indications! /omplete or partial reversal of the sedative effects of !en:odia:epines.
%osage,Administration!
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1luma:enil is administered !y rapid IV push (over "3 to 72 seconds).
Adults!
-ose to reverse !en:odia:epine 5 induced sedative effects after anesthesia or conscious
sedationF
2.$ mg given IV o$er ./ seconds; this dose may !e repeated after 83 seconds and
every minute thereafter prn to a total dosage of " mg during the initial 3#minute period.
If re#sedation the initial dosing regimen (i.e. up to " mg given in divided 2.$ mg doses
at "#minute intervals) may !e repeated no more fre(uently than every $2 minutes up to
a ma'imum of 7 mg in any "#hour period.
-ose for !en:odia:epine overdoseF
2.$ mg over 72 seconds followed if necessary !y 2.7 mg after 72 seconds. 1urther
doses of 2.3 mg over 72 seconds may !e given at "#minute intervals to a cumulative
dosage of 7 mg.
Pediatrics
"2 mg*kg ' " then continuous infusion at 3mg*kg*hour; or 2.$ mg followed !y 2." mg each
minute until awake. Ma'imum total dose " mg.
Ad$erse Reactions! -eath (after tricyclic antidepressant overdose) convulsions pain at in,ection
site nausea*vomiting agitation.
+ontraindications! Dnown hypersensitivity patients receiving !en:odia:epines to treat potentially
life threatening conditions (i.e. sei:ures) known tricyclic antidepressant overdose.
#urosemide 'Lasi*(
+lass! -iuretic
Indications! .dema due to renal dysfunction /01 and hepatic cirrhosis; hypertension.
%osage,Administration!
Adult!
)sual initial doseF $2#82 mg (dose should !e individuali:ed to the patientEs needs and
response)
Pediatrics!
" mg*kg dose initially every 8#"$ hours to a ma'imum dose of "2 mg*kg*$8 hours
May !e administered IM IV push or !y IV infusion.
1or direct IV in,ection in,ect slowly over . to 0 minutes.
1or IV infusion various rates of administration have !een used. 9ates not e'ceeding 8
mg*min have !een recommended to prevent ototo'icity.
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Ad$erse Reactions! 0igh doses and prolonged therapy may result in profound diuresis (which may
result in fluid and electrolyte distur!ances hypotension and arrhythmias). 4ausea*vomiting
urticaria hypokalemia electrolyte im!alances and dehydration.
+ontraindications! Dnown hypersensitivity to 1urosemide or sulfonamides anuria electrolyte
im!alances. Jasi' has multiple drug interactions and may lead to significant to'icity related to
interactions with aminoglycoside anti!iotics digitalis and lithium.
8e5arin
+lass! %nticoagulant
Indications! Venous throm!osis pulmonary em!olism MI
%osage,Administration!
;pecific doses vary and are dependent upon the therapeutic use and route of administration.
Adult!
Initial dose 3222#"2222units IV every 8#? hours according to P&& values
Pediatrics!
"22units*kg*dose every 8 hours
Ad$erse Reactions! 0emorrhage local irritation chills fever pruritis urticaria.
+ontraindications! Dnown hypersensitivity severe throm!ocytopenia and uncontrolled active
!leeding states.
8ydrocortisone Sodium Succinate 'Solu7+ortef(
+lass! ;ynthetic /orticosteroid
Indications! %drenal insufficiencies ;J. allergic states ulcerative colitis.
%osage,Administration!
Adults!
)sual dosage "22#322 mg dose two#four times a day (-osage must !e individuali:ed to the
patientEs needs and response)
Pediatrics!
"#$ mg*kg*dose IV !olus then $3#"32 mg*$8 hours for infants*young children and "32#$32
mg*$8 hours for older children in divided doses.
May !e administered !y su!cutaneous intravascular intra#articular IV push continuous or
intermittent IV infusion. +hen hydrocortisone sodium succinate is administered !y direct IV
push it should !e administered over at least 72 seconds.
Ad$erse Reactions! 1luid retention /01 muscle weakness convulsions.
+ontraindications! Premature infants systemic fungal infections sensitivity to sulfites (certain
in,ecta!le forms contain sulfites)
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Lora4e5am 'Ati$an(
+lass! %ntian'iety (Ben:odia:epine derivative)
Indications! %n'iety agitation acute sei:ure control.
%osage,Administration!
Adults!
"#"2 mg*day
Pediatrics!
2.27#2." mg*kg*dose
May !e administered !y IM or !y IV (when diluted immediately !efore use with an e(ual
volume of 2.@A normal saline or de'trose 3A in water).
IV in,ection is made directly into a vein or into the tu!ing of a running IV infusion at a rate not
e*ceeding 0 mg,min.
Ad$erse Reactions! ;edation
+ontraindications! Dnown sensitivity children under "$ years acute angled glaucoma psychoses
mental depression.
Me5eridine '%emerol(
+lass! 4arcotic analgesia
Indications! Pain control sedation analgesia
%osage,Administration!
Adults!
32#"32 mg every 7#8 hours or "3#73 mg*hour continuous IV infusion.
Pediatrics!
9arely administered to pediatric patients.
Prefera!ly given IM. May !e given su!K IV push or IV infusion in a diluted solution. A .37
mg,ml concentration has &een recommended for slow IV 5ush.
+hen Meperidine is given parenterally especially !y the IV route the patient should !e lying
down.
Ad$erse Reactions! 9espiratory depression light headedness di::iness nausea*vomiting
sweating.
+ontraindications! Dnown hypersensitivity patients who have received monoamine o'idase
inhi!itors within "8 days.
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Methyl5rednisolone Sodium Succinate 'Solu7Medrol(
+lass! ;ynthetic /orticosteroid
Indications! %drenocortical insufficiencies ;J. allergic states ulcerative colitis
%osage,Administration!
Adults!
)sual IV doses "2#$32 mg repeated up to ? times daily (-osage must !e individuali:ed to the
patientEs needs and responses).
Pediatrics!
$ mg*kg IV ' " then 2.3#".2 mg*kg IV every ? hours.
May !e administered !y IM intra#articular IV push or IV infusion. -irect IV in,ections should
!e administered over several minutes.
Ad$erse Reactions! 1luid retention /01 muscle weakness convulsions.
+ontraindications! Premature infants systemic fungal infections sensitivity to sulfites (certain
in,ecta!le forms contain sulfites)
Metoclo5ramide 'Raglans(
+lass! %ntiemetic
Indications! ;ymptomatic gastric reflu' nausea vomiting (prophyla'is)
%osage,Administration!
Adults!
$mg*kg IV every $ hours for 3 doses to prevent nausea associated with chemotherapeutic
agents. "2#$2 mg IV every 8#? hours.
Pediatrics!
2." mg*kg*dose for >I 9eflu' and >I 0ypomotility. $.3 mg*kg*dose IV for "#$ doses to prevent
nausea associated with chemotherapeutic agents. %dminister 72 minutes prior to
chemotherapy and $ hours after completion of chemotherapy. /ontinuous IV infusion at 2.8
mg*kg*hour.
%dminister !y IM or direct IV in,ection without dilution or !y intermittent IV infusion. -oses
e'ceeding "2 mg should !e diluted in 32 ml of a compati!le diluent and administered over at
least "3 minutes.
By direct IV in,ection each .3 mg of the drug should &e gi$en o$er .70 minutes since a
transient !ut intense feeling of an'iety and restlessness followed !y drowsiness may occur with
rapid IV in,ection.
Ad$erse Reactions! 9estlessness hypotension visual distur!ance nausea.
+ontraindications! +henever stimulation of the gastric motility might !e dangerous epileptic
patients or patients with pheochromocytoma.
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Mor5hine Sulfate
+lass! 4arcotic analgesic
Indications! Pain control sedation analgesia
%osage,Administration!
Adults!
3#$2 mg su!cutaneous or IM; or $.3#"3 mg IV every 8 hours.
Pediatrics!
2." mg*kg*dose every $ hours up to a ma'imum of "3 mg*dose.
Morphine is not recommended to !e administered IV unless a narcotic antagonist and facilities
for assisted respirations are immediately availa!le.
+hen given IV $.3 to "3 mg diluted in 8 or 3 ml sterile -3+ for in,ection and in,ected over 8#
3 minutes. Patients should !e lying down during administration.
Ad$erse Reactions! 9espiratory depression light headedness di::iness nausea*vomiting
sweating.
+ontraindications! Dnown hypersensitivity to this drug or other opiate analgesic.
Nalo*one 'Narcan(
+lass! 4arcotic antagonist
Indications! Partial or complete reversal of narcotic depression.
%osage,Administration!
Adult!
2.8 to $ mg IV with repeated doses at $ to 7 minute intervals to a ma'imum of "2 mg for
narcotic overdose.
Pediatrics!
2." mg*kg*dose as re(uired to maintain opiate antagonism.
May !e administered su!cutaneous IM or IV in,ection or !y continuous IV infusion. IV push is
recommended in emergency situations.
Ad$erse Reactions! 4ausea*vomiting after high doses
+ontraindications! Dnown hypersensitivity.
Pheno&ar&ital Sodium 'Luminal Sodium(
+lass! 0ypnoticF anticonvulsant !ar!iturate sedative
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Indications! &o control agitation an'iety and insomnia. &o treat and prevent to'ic#clonic
sei:ures*convulsions.
%osage,Administration!
Adult!
32#"22 mg two#three times per day.
Pediatrics!
Maintenance doseF 3#6 mg*kg*$8 hours for infants and 7#3 mg*kg*$8 hours for children.
;tatus epilepticusF "2#$2 mg*kg to a ma'imum of 722 mg; followed !y 3#"2 mg*kg*dose at $2
minute intervals until sei:ures cease.
Ad$erse Reactions! -rowsiness asthma urticaria parado'ical restlessness or e'citement
respiratory depression.
+ontraindications! Dnown !ar!iturate sensitivity previous addiction liver impairment respiratory
disease with -yspnea or o!struction nephritis !reast#feeding patients.
Prometha4ine 'Phenergan(
+lass! %ntiemetic; antihistamine
Indications! %llergic reactions nausea vomiting ad,unct to analgesia.
%osage,Administration!
Adults!
"$.3#32 mg every 8#? hours.
Pediatrics!
2."#2.3 mg*kg*dose every ?#"$ hours.
+hen given !y direct IV in,ection a concentration no greater than $3 mg*cc at a rate not
e'ceeding $3 mg*min should !e used.
%dminister orally deep IM IV in,ection continuous or intermittent IV infusion.
+hen prometha:ine is given IV e'treme care should !e e'ercised to prevent e'travasation or
inadvertent intra#arterial in,ection !ecause chemical irritation may !e severe and cause severe
arteriospasm. ;ince prometha:ine discolors !lood on contact aspiration of dark !lood at the
site of in,ection does not rule out the possi!ility of intra#arterial placement of the needle. If the
patient complains of pain at the in,ection site during presumed IV in,ection the in,ection should
!e immediately stopped and the possi!ility of intra#arterial placement of the needle or
perivascular e'travasation should !e evaluated.
Ad$erse Reactions! -i::iness drowsiness hypotension.
+ontraindications! 0ypersensitivity to prometha:ine or phenothia:ines.
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Rho '%( Immune Glo&ulin for IP '9inRho S%(
+lass! Immune >lo!ulin
Indications! &reatment of non#splenectomi:ed 9ho (-) positive children with chronic or acute
Idiopathic &hrom!ocytopenic Purpura (I&P); adults with chronic I&P.
%osage,Administration!
9econstitute with 2.@A ;odium chloride only.
Initial dose $32 international units (32 micrograms*kg) IM or IV.
If hemoglo!in is less than "2 grams*deciliter reduce dose to "$3#$22 international units ($3#82
micrograms*kg).
Action! Increases platelet count to prevent hemorrhage.
Ad$erse Reactions! -ecreased hemoglo!in headaches chills and fever.
+ontraindications! Dnown reactions to human glo!ulins.
)I)LI:GRAP8;
*enit+, ,$-$ and .atro$ /$S$ ."e Pediatric /rug Handoo0$ 1
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-dition 2 344( y Mosy5
St$ Louis, M6$
."e Li##incott Manual of Nursing Practice$ (
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-dition 2 3443 y 7* Li##incott Com#any$
##$ 8498&
Nursing 4( /rug Handoo0 2 344( y S#ring"ouse Cor#oration$
Princi#les : Practice I! ."era#y$ 4
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-dition 2 348& y Ada La;rence Pulmer$
##$ 184918&
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