N241 – IV Push Guidelines for Skills Lab & IVP Competency
Name: ___________________________________________ Clinical Group: _________________
Four (4) students must sign you off prior to attempting competency assessment.
1.
2.
3.
4.
Competent – Instructor signature______________________________Date___________________
Not competent – Instructor signature___________________________Date___________________
Number of attempts: ______________________________________________________________
Comments:______________________________________________________________________
----------------------------------------------------------------------------------------------------------------------You will learn common guidelines but you are only to do limited peripheral IV push medications in the
clinical setting which includes saline lock flushes under the supervision of your instructor or facility RN
once you have achieved competency.
MEDICATIONS approved for students to administer IVP in clinical setting with instructor or RN:
Dexamethasone (Decadron)
Furosemide (Lasix)
Famotidine (Pepcid)
Metoclopramide (Reglan)
Methylprednisolone Sodium Succinate (Solu‐Medrol)
Morphine Sulfate
Ondansetron (Zofran)
Pantoprazole (Protonix)
The IV push route provides a method of administering high doses of medications; this route can be
accomplished by direct vein penetration, an intermittent device, or by access of the low injection
port on the primary administration set; all medication is bioavailable; patient is closely monitored
during full administration.
Highlights to remember:
 IV heparin, IV insulin, IV digoxin requires another RN to verify.
 KCL, and antibiotics are never given IV push.
 Evaluate patient’s response: remember about speed shock: a foreign substance that is introduced
into the circulation, medication in plasma reaches toxic levels, floods the organisms rich in blood
(heart and brain) and can cause syncope (LOC changes), shock and cardiac arrest.
 Check allergies, verify order, educate patient regarding the purpose of therapy, document the
procedure.
 Remember about First Dose Teaching Guidelines.
 If you notice any leaking or inflammation, do not initiate IV push or continue with push
procedure.
 Do not use needles longer than 1” in length; if interlink equipment is in use, you can still use
needles.
 You can use Twin-Packs or Clearlink. Please try to use needleless system. Don’t use the needle
portion of the TwinPak. Clearlink or Smartsite requires no needles.
 Cleanse ports with alcohol in a circular motion. (15 seconds; 30 seconds if immunosuppressed)
 During the competency, talk out loud amount drawn up and amount given every 15 seconds (i.e.
0.25mL)
Medications given using a locking device (NS Lock)
□ 1. After being given situation, lift open the lap top work station or open the windows from the task bar.
State, “I have read the order and it is complete”. Wash or degerm hands.
□ 2. Check medication with online Doctor Order and state patient allergy status. ** This can be a first
check.
□ 3. Select equipment; NS flush and correct medication. Check the medication and NS flushes 3
TIMES using the 5 rights. Med    NS Flush   
**** Three checks must be done prior to the med being given. Student cannot say they did this
during or after the procedure has been performed. *****
□ 4. If drug appropriate, verify medication and dosage with another RN prior to withdrawing needle
from vial using MAR.
□ 5. Label IV medication to differentiate from NS syringes.
□ 6. Partially close Mobile Station or windows and take with you to the bedside. It is helpful to state
you are protecting the patient information from others viewing and abiding by HIPPA regulations.
□ 7. Degerm when entering patient’s room.
□ 8. Professionally introduce self to patient and include purpose of visit.
□ 8a. If patient shares the room with another patient, ask permission to speak about medications
(HIPAA guidelines).
□ 9. Open Mobile Station or windows.
□ 10. Check patient identification, and medical record number and allergy status (make sure to ask the
patient if she has any allergies), must do two patient safety checks) using the MAR.
□ 11. Take and report assessment parameters prior to administering medication.
(Clean equipment prior with alcohol prep.) **Morphine = BP, RR, Pain scale. Lasix = BP
□ 12. Tell patient what medication is ordered for.
□ 13. Visually inspect (do not touch) insertion site by observation and verbalize the condition.
□ 14. Degerm hands.
□ 15. Don disposable gloves.
□ 16. Cleanse port with alcohol in a circular motion, and allow to dry (15 seconds or 30 seconds for
immunocompromised pt.).
□ 17. Open slide clamp.
□ 18. Flush lock first with 0.9%NS to determine patency prior to medication administration. Closely
observe insertion site for patency.
□ 19. Dispose of syringe in sharp’s container.
□ 20. Cleanse port with alcohol, allow to dry, administer the drug at the prescribed rate (inject 1/4 of
medication into patient every 15 sec.) and assess patient closely during the procedure - closely
observe insertion site for patency.
□ 21. Dispose of syringe in sharp's container.
□ 22. After drug delivery, cleanse with alcohol, allow to dry and flush the lock with 0.9%NS
Closely observe insertion site for patency.
□ 23. Simultaneously close slide clamp while maintaining positive pressure on the plunger of the
Syringe.
□ 24. Dispose of syringe in sharp's container.
□ 25. Remove gloves and dispose of garbage.
□ 26. Degerm.
□ 27. Give call light.
□ 28. Degerm
□ 29. Inform patient you will be back to check on them in 15-30 minutes but encourage that they can
call you if necessary.
□ 30. Document on the Electronic MAR. (correct date, time, slot, initials, med + NS flushes, signature
With CSM SN)
□ 31. Minimize screen or partially shut the laptop.
□ 32. Return to check on patient.
□ 33. Degerm - entering and leaving patient’s room.
TOTAL time should not exceed 15 minutes.
Medications given using a continuous infusing primary line
□ 1. After being given situation, lift open the lap top work station or open the windows from the task bar.
State, “I have read the order and it is complete”. Wash or degerm hands.
□ 2. Check medication with online Doctor Order and state patient allergy status. ** This can be a first
check.
□ 3. Select equipment; NS flush and correct medication. Check the medication and NS flushes 3
TIMES using the 5 rights. Med    NS Flush   
**** Three checks must be done prior to the med being given. Student cannot say they did this
during or after the procedure has been performed. *****
□ 4. If necessary, verify medication and dosage with another RN prior to withdrawing needle from
vial.
□ 5. Label IV medication to differentiate from NS syringes.
□ 6. Partially close Mobile Station or windows and take with you to the bedside. It is helpful to state
you are protecting the patient information from others viewing and abiding by HIPPA regulations.
□ 7. Degerm when entering patient’s room.
□ 8. Professionally introduce self to patient and include purpose of visit.
□ 8a. If patient shares the room with another patient, ask permission to speak about medications
(HIPAA guidelines).
□ 9. Open Mobile Station or windows.
□ 10. Check patient identification, and medical record number and allergy status (make sure to ask the
patient if she has any allergies), must do two patient safety checks) using the MAR.
□ 11. Take and report assessment parameters prior to administering medication.
(Clean equipment prior with alcohol prep.) **Morphine = BP, RR, Pain scale. Lasix = BP
□ 12. Tell patient what medication is ordered for.
□ 13. Visually inspect (do not touch) insertion site by observation and verbalize the condition.
□ 14. Degerm hands.
□ 15. Don disposable gloves
□ 16. Swab lowest Y port with alcohol; allow to dry and flush with 1 mL NSS (if pre-filled use 3 mL
NS) after pinching tubing (by folding it over) from primary line; closely observe insertion site for
patency.
□ 18. Dispose of syringe in sharp's container.
□ 19. Cleanse port with alcohol, allow to dry and insert syringe with medication into the lowest Y site.
□ 20. Pinch tubing (fold it over) to primary solution right above the Y port.
□ 21. Inject one quarter of medication into patient over a 15-20 second period.
□ 22. Unpinch tubing, allow the primary solution to flush for 5 seconds after pushing the primary start
button. Watch patient for any adverse reactions.
□ 23. Repeat steps 20-23, delivering one quarter of the drug each time for three more times, closely
observing insertion site for patency.
□ 24. When all the desired drug is delivered, remove syringe.
□ 25. Dispose in sharp’s container.
□ 26. Cleanse lowest Y port with alcohol, allow to dry and flush with 3 mL NS flush if pre-filled after
pinching tubing (by folding it over) from primary line and observing for patency.
□ 27. Allow primary line to straighten.
□ 28. Dispose of syringe in sharp’s container.
□ 29. Dispose of garbage. Wash hands. (degerm)
□ 30. Give call light.
□ 31. Inform patient you will be back to check on them in 15-30 minutes, but encourage patient to call
you if necessary.
□
□
□
□
32. Document on MAR medication and NS flushes.
33. Minimize MAR.
34. Return to check on patient.
35. Degerm – entering and leaving patient’s room.
TOTAL Time must not exceed 15 minutes.