N241 – Advanced Medical-Surgical Nursing
IV Push Policy
Background: I.V. push administration (direct injection) of a medication is used to provide the patient with
a rapid onset of the medication to achieve rapid serum concentration (therapeutic levels). The advantages
include: a) direct and fast bioavailability of the medication and b) response is usually immediate. The patient
must be closely monitored during the administration process. The disadvantages include: a) adverse effects
can occur at the same time and rate as therapeutic effects and b) potential for infection if the medication or
access devices are contaminated during the procedure. Since the medication is 100% bioavailable, there is a
greater risk of adverse effects and toxicity. Lastly, speed shock is a consequence from too rapid
administration.
The RN student encounters daily orders for IV push medications while delivering direct patient care to
individuals in the clinical setting. Therefore, it is necessary to develop a policy that will establish the criteria
for the RN student administering IV push medications, which also include peripheral Normal Saline Lock
flushes.
Purpose: To allow the RN student (second year) at College of San Mateo to administer IV push
medications. The following medications will be permitted:
Dexamethasone (Decadron)
Furosemide (Lasix)
Famotidine (Pepcid)
Metoclopramide (Reglan)
Methylprednisolone Sodium Succinate (Solu‐Medrol)
Morphine Sulfate
Ondansetron (Zofran)
Pantoprazole (Protonix)
Students will deliver the above medications:
1) Through a peripheral intravenous line only. No central, percutaneous central line or epidural
catheters may be used.
2) After the medication has been given at least one time – cannot administer the initial dose of the
IVP medication (ID)
Policy: A second year student may perform IV Push skill with only the above medications.
Administration of all medications, especially via the IV Push method, is contingent on the competency of the
student. The student must pass the IV competency (N241) before administering an IV Push medication in
the clinical setting. In addition, the student must be aware of the indications, actions, side effects,
contraindications, correct dosage and alternative routes for delivering the medication.
Students should be advised of the policy and procedure guidelines for administering medications via IV Push
of the clinical facility to which they are assigned and MUST adhere to these specific guidelines, in addition to
the CSM IVP policy. When the student performs this skill for the first time, in clinical, the student must
be accompanied by the instructor. AS ALWAYS, A STUDENT MAY NOT ADMINISTER ANY
MEDICATION WITHOUT BEING IN THE DIRECT SUPERVISION OF THEIR CLINICAL
INSTRUCTOR (OR THE STAFF RN AFTER THE CLINICAL INSTRUCTOR HAS GIVEN
PERMISSION TO DO SO). This includes the administration of normal saline flushes via the IVP
route. It is at the clinical instructors discretion to allow the student the subsequently perform this task
with staff RNs or not. Please be aware that each clinical setting is different, and the patient population
changes daily. Clinical instructors are responsible for patient, student and staff safety. Therefore, instructor
discretion is imperative.
Updated Spring, 2014 by T.DeVille – Approved by N241 faculty.
N241 – Advanced Medical-Surgical Nursing
IV Push Policy
Competency assessment: Students will be assessed by their clinical instructor using the CSM
IVP checklist. All students must complete the following PRIOR to the IVP competency
assessment scheduled date:
1) ATI - Skills Modules – tutorial - Medication Administration 4
 Pre-test
 Tutorial
 Post-test
2) practice in open skills lab and have 4 peers observe performance and sign stating the student
performed the task in compliance with the checklist
Evidenced-based practice resources students should use are current editions of the following
required textbooks and online resources:
1) The above listed ATI tutorial, as well as the ATI Pharmacology textbook.
2) Phillips’ Manual of IV Therapeutics.
3) Perry, Potter, & Keene’s Nursing Interventions and Clinical Skills.
Updated Spring, 2014 by T.DeVille – Approved by N241 faculty.