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  1. Pritchett, Deborah PharmD, BCPS, BCPPS
  2. Bjornson, Tige MSN, CNP, NNP
  3. Randall, Kristine BAN, CCRN
  4. Walsh-Sunde, Anita ADN, CCRN
  5. Nygaard, Carol BA, RNC-NIC
  6. Jarman, Ashley BSN, RNC-NIC
  7. Schumacher, Bette MS, RN, CNS


Background: Neonatal intensive care unit (NICU) infants frequently require peripherally inserted central catheter (PICC) placement for medication and nutrition. The occurrence of leaking catheters led to practice evaluation of manual intravenous (IV) flush and medication push technique in an upper Midwest NICU. A variation in unit practice was revealed.


Purpose: To describe an evidence-based practice change that standardized medication administration, eliminating routine manual IV push medication and flush administration and reducing catheter malfunction. Emergency "code" medication administration was not addressed.


Methods: A systematic review of the literature was performed. A unit practice investigation ensued to study medication administration techniques and syringe size utilization, understand syringe pressure generated by various sizes of syringes, select optimal IV tubing supplies, review the smart pump library, electronic order sets/documentation, and address staff knowledge and skills. Practice change eliminating IV push and recommendations incorporating best evidence occurred.


Results: Moving from a traditional method of manual pushing/flushing medication to use of medication delivery via smart pump can decrease or eliminate PICC damage and potential harm to neonatal patients.


Implications for Practice: Examination of IV push technique may identify opportunities for safer medication administration. Use of an infusion pump and a dedicated medication line can be a feasible option to deliver most IV medication doses in the NICU.


Implications for Research: Safe medication administration practices for the neonatal population and barriers to that practice.


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