2.5 Checklist: Administer IV Push Medications

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Administer IV Push Medications^{[1],[2],[3],[4]}

• Verify the provider’s order.
• Review the patient’s medical record for factors that increase the patient’s risk of adverse reactions and toxicity to the prescribed medication. Check for allergies or any other contraindication to the prescribed medication. Verify when the last dose of this medication was administered, the indication for this medication for this patient, and related pre-administration assessments, vital signs, lab results, or other clinical data.
• Gather and prepare the necessary equipment: syringe, medication, saline flush, antiseptic pads, and needle/vial access device.
• If medication preparation is required, do so in a designated clean, quiet environment away from sinks using the aseptic non-touch technique (ANTT).^[5]
• Check the expiration date on the medication. If it’s expired, return it to the pharmacy and obtain new medication. Inspect the medication for discoloration or compromised integrity.
• Verify the medication can be given by bolus based on agency policy.
• Confirm the following information in a drug reference guide: appropriate dosage, need for dilution or reconstitution, compatibility with running IV fluids and medications, rate of administration, action of medication, potential adverse effects, antidote, and patient education.
• Perform hand hygiene.
• Confirm patient identity using at least two patient identifiers and ask about allergies.
• Provide privacy.
• Explain the procedure to the patient. Provide education regarding the medication, its purpose, and potential side effects.
• Perform necessary pre-administration assessments in accordance with the type of medication being given.
• Raise the bed to waist level when providing care.
• Perform hand hygiene and put on gloves. Adhere to standard aseptic non-touch technique (ANTT) when preparing medication, administering IV push medication, flushing, and locking venous access devices.^[6]
• If the medication is not in a prefilled syringe and dilution is required, dilute it and draw it up in a syringe using sterile technique. Do not dilute or reconstitute IV push medications by drawing up the contents in a commercially prefilled saline flush syringe.^[7] Only dilute medications when recommended by the manufacturer, supported by evidence in peer-reviewed biomedical literature, or in accordance with approved agency guidelines.
• Check the rights of medication administration X 3 while preparing the medication. When performing three checks, check against the provider order, check as you are reaching for the medication, and check right before administering the medication.
• Prepare one medication syringe at a time. Label all IV push medication syringes unless they are prepared at the bedside and immediately administered. Never pre-label an empty syringe in advance of its use.^[8]
• If continuous running IV fluid is compatible with the medication, pause the infusion. Trace the IV line from the patient to its point of origin and use the port closest to the patient and clamp the line.
• If a saline lock is in place, unclamp the catheter.
• Perform a vigorous mechanical scrub of the needleless connector for at least five seconds using 70% alcohol or an alcohol-based chlorhexidine solution and then allow the connector to dry completely. Do not fan or wave over the site.
• Assess the venous access device prior, during, and after administering IV push medication for signs and symptoms of complications, such as pain, infiltration, phlebitis, or extravasation.
• Assess for patency using a single-use 10-mL syringe with 0.9% normal saline. While maintaining the sterility of the syringe tip, attach the syringe to the needleless connector port. Slowly aspirate for blood return. Patency is determined by evidence of brisk, bright red blood return, although blood return is not always present. Slowly inject preservative-free normal saline solution into the catheter. Never forcibly flush a venous access catheter. Remove and discard the syringe.^[9]
• Perform a second vigorous mechanical scrub of the needleless connector with a new swab for at least five seconds and allow it to dry completely.
• Maintaining the sterility of the syringe tip, attach the medication syringe to the needleless connector of the venous access device. Administer the medication at the recommended rate of administration according to the MAR, drug reference guide, or manufacturer using a watch or clock with a second hand. Remove and discard the syringe.
• Perform a third vigorous mechanical scrub of the needleless connector with a new swab for at least five seconds and allow it to dry completely.
• Maintaining the sterility of the syringe tip, attach a prefilled 10-mL syringe containing preservative-free 0.9% normal saline to the needleless connector and flush at the same rate of administration as the medication. The volume of the flush should be twice the internal catheter volume (i.e., a J-loop would be 2 mL and extension tubing would be 4 mL). Continue to flush at a slow, steady pace to clear the line, typically another 2 to 7 mL.^[10]
• If continuous IV fluids are present, unclamp the tubing and resume the infusion. If locking the venous access device, follow agency policy regarding the sequence of flushing, clamping, and disconnecting the syringe.
• Discard used supplies in appropriate receptacles.
• Remove and discard the gloves.
• Perform hand hygiene.
• Return the bed to the lowest position. Provide for patient safety and comfort.
• Evaluate patient response to the medication and monitor for adverse reactions based on the onset and peak of the prescribed medication. Instruct the patient to call the nurse if feeling any adverse effects.
• Document the administration of the medication per agency policy.