[cute_cabbage2005]

I have a question. Im a new nurse. When I was a student nurse, my preceptor then always diluted her many of her bolus meds in 10cc normal saline before she injected into the IV port.

As a grad nurse, my preceptor doesnt do this. For example in giving 2cc lasix she just pops the medication into the IV line, then flushes it with 10cc normal saline afterwards. Is this okay? Even when using a PICC line, she only flushes with normal saline. Shouldnt she flush PICC line with heparin also?

[calla2114]

You do not always have to dillute meds. I do it sometimes to make it easier to go slow!! Much easier to push 10cc over 2 min than 2cc..Know what I mean? Also we have PICC lines at our facitily that are heparin free. So we only flush with NS. Why not ask you preceptor if that is the case there too?

[nursbee04]

Ditto what calla said - Not everything has to be diluted - always check an IV drug reference if you are unfamiliar with ANY medication. Any good reference source should tell you how much to dilute in or "may be given undiluted." It should also tell you rate of infusion, contraindications, etc.

Solumedrol, for example, I don't dilute. I dilute lasix - but if there are IV fluids going compatible with the lasix, sometimes I'll give it undiluted into the IV tubing port, because the fluid running is diluting it for me. This may be what your preceptor is doing.

Have you asked your preceptor about this?

Also, our facility no longer uses heparin for our PICC lines. They are locked with saline. Always check you facility's policy and procedure manual if you are unsure.

[Agnus]

picc lines are no no longer flushed with heparin.

Reguardless of weather you dilute or not you need to push slow with MOST medications. GENERAL rule of thumb is 1 ml per minute. No faster. There are a few exceptions.

Lasix comes 10 per ml in the vial. Pushing it too fast can = ototoxicity.

Meds that are caustic or irritating (lasix is not one of these) or thick and or oily like Atavan should be diluted.

Dilution can help you to push a small amt of med slower but it is possible to control the rate of push if you are careful without diluting.

[twinmommy+2]

Originally Posted by cute_cabbage2005

I have a question. Im a new nurse. When I was a student nurse, my preceptor then always diluted her many of her bolus meds in 10cc normal saline before she injected into the IV port.

As a grad nurse, my preceptor doesnt do this. For example in giving 2cc lasix she just pops the medication into the IV line, then flushes it with 10cc normal saline afterwards. Is this okay? Even when using a PICC line, she only flushes with normal saline. Shouldnt she flush PICC line with heparin also?

One thing we were told by vascular therapy at my hospital was through any central or picc line one must use nothing smaller than a 10cc syringe, since the pressure exurted on the other end was less and would not harm the end of the catheter.

[november551]

I never dilute my IVP meds unless it is indicated to do so. I figure the less you're playing around with putting stuff in different containers, mixing, etc, the better. Diluting just seems like an unnecessary step to me but to each their own.

[aeauooo]

Originally Posted by Agnus

picc lines are no no longer flushed with heparin.

Reguardless of weather you dilute or not you need to push slow with MOST medications. GENERAL rule of thumb is 1 ml per minute. No faster. There are a few exceptions.

Lasix comes 10 per ml in the vial. Pushing it too fast can = ototoxicity.

Meds that are caustic or irritating (lasix is not one of these) or thick and or oily like Atavan should be diluted.

Dilution can help you to push a small amt of med slower but it is possible to control the rate of push if you are careful without diluting.

I agree with all of the above, but will add that Lasix (furosemide) pushed too fast will cause hypotension - 10mg/min.

Dilantin (phenytoin) and Valium (diazepam) are extremely caustic and incompatable with anything other than normal saline. Fortunately, most places now use fosphenytoin instead of phenytoin (although I had to push phenytoin a couple of months ago on the bone marrow unit - why, I don't know), and it's been many years since I've pushed diazepam. The rule for phenytoin is 50mg/min, fosphenytoin can be given at 100mg/min. Fosphenytoin is also compatable with most IV solutions.

Phenergan also needs to be diluted in 10ml of saline.

The rate of your IV fluids can also determine whether or not you need to dilute - high rates of flow can adequately dilute less caustic drugs (Ativan).