Advantages

Intravenous push (IV push) is a process of introducing a medication or fluid substance directly into the bloodstream via the venous system. When the medication is administered directly into the bloodstream, it immediately enters the circulatory system and travels to a site of action. Administering the medication directly into the bloodstream reduces the first-pass effect or the action that occurs when a medication must be first metabolized or broken down prior to entering the blood. First-pass effect results in a diminished volume of available circulating drug and a subsequent decrease in therapeutic action.[1] As a result, when utilizing IV push medications, a decreased dosage of medication can be given compared to an oral dosage to achieve the same therapeutic effect.

First-pass metabolism significantly impacts the bioavailability of many medications. For example, larger oral doses of morphine must be provided than intravenous dosages to obtain the same therapeutic pain relief, but the risks of oversedation and respiratory depression are higher with intravenous doses. Nurses who have concerns about an ordered dose of intravenous medication should clarify the dosage with the pharmacist and/or prescribing provider before administering it.

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Intravenous medication administration also has a more rapid onset than oral medication. Because the bioavailability of the medication is directly in the circulatory system, the medication is readily transported to the site of action. This is a significant benefit when a rapid response is needed, such as when clients are experiencing severe hemodynamic instability or severe pain.

Let’s consider the following scenario: A nurse on a medical telemetry unit received a direct admission from a cardiac clinic for an 85-year-old male client admitted with an exacerbation of chronic heart failure. The client’s vital signs are heart rate 102, blood pressure 144/88, respiratory rate 24, and pulse oximetry reading of 90% on room air. The nurse listens to the client’s lung sounds and notes crackles in both posterior lungs. The nurse reviews the admitting orders from the provider and sees an order for furosemide 40 mg IV push STAT. Review furosemide’s drug action profile in Table 2.2a and note the different onsets of action for the different routes of furosemide. It is clear that the IV push route of administration will work quickly to remove this client’s excess fluid and positively impact their respiratory status.

Intravenous medication administration can also be of great benefit when clients are experiencing gastrointestinal issues that may affect absorption, such as impaired swallowing or esophageal, stomach, or intestinal absorption issues. Administering a medication directly into the cardiovascular system allows the substance to freely circulate throughout the body and bypass the breakdown and absorption barriers created by the gastrointestinal tract. See Figure 2.1[3] for an image of a nurse administering IV push medication.

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In addition to rapid onset, some medications are only formulated to administer via the IV route, such as certain vasoactive substances. As a result, many patients who are hospitalized may have an “IV lock” inserted to facilitate rapid IV access if their condition deteriorates. An IV lock (also referred to as a “saline lock”) is an IV cannula that has been inserted into a peripheral vein with a short extension tube that is filled with saline and clamped to keep the cannula patent. This type of IV access may also be referred to as a “peripheral lock” because it is inserted into the peripheral vasculature. Historically, many IV locks were flushed with heparin to keep the line from clotting, so they were referred to as a “heparin lock” or “hep lock.” Although evidence-based practice no longer recommends heparin be used to maintain patency of a peripheral IV access device, the name “hep lock” may still be used in practice. An IV lock is beneficial because it provides rapid access to administering medications in the venous system if needed, but continuous infusion of medication or fluid is not required.

IV push medication can also be a valuable alternative route of administration for clients at risk for fluid volume overload. For example, clients who are experiencing acute renal failure or an acute exacerbation of heart failure may benefit from IV push medications administered with smaller amounts of fluids compared to a typical IV infusion of medication.[4]

One of the most obvious benefits of IV push medication administration from a client’s perspective is that it does not require repeated needlesticks for administering repetitive doses of medications intramuscularly or subcutaneously. As a result, client discomfort is minimized when intravenous access can be maintained.

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