Dilute IV meds or not?

[HappyJaxRN]

I followed behind a nurse who said that she dilutes all her IV meds before giving them. I was told last year when precepting that you don't have to and it really doesn't do the patient harm if you don't. So I haven't been, until a couple of days ago...I have giving 5mg IV Lopressor and felt compelled to dilute it with 2ml of NS. So I was doing that....

But now I look back and wonder, how many of you guys dilute your IV meds? It's not really necessary....Most of the meds we push IV are in Central Lines and PICC's. What's your thought?

[Burnt Out, ASN, RN]

About the only things I dilute are Ativan, Phenergan, Lanoxin, and Morphine. I haven't seen any contraindications to diluting these drugs.

[zambezi, BSN, RN]

IV lopressor is a quick drug- it's onset is considered immediate...peaks in 20 minutes and the duration is 5-8 hours. PO lopressors onset is 15 minutes and the duration is 6-12 hours. We use a lopressor protocol frequently for our MI patients (as I am sure that many hosptials do). Our protocol calls for 5 mg IV lopressor to be given over 30 seconds. 2 minutes later we give another 5 mg dose over 30 seconds. We wait 5 minutes and if tolerated, give another 5 mg dose over 30 seconds. If in 15 minutes, all of this is tolerated- we start 50 mg PO Q6 hours- of course we monitor HR and BP pretty closely thoughout the whole procedure and have some stop parameters as well.

You can give it direct IV without diluation and per the drug book it can be "given rapidly" so you don't need to stand there for 5 minutes.

As for dilution, I don't usually dilute anything unless it specifically states that it has to be diluted (or if I am giving ativan/phenergan or something else that is fairly "thick" or caustic). I don't actually think that I have ever given phenergan IV...If I have a tko line, I do try to push meds through that...but i use the low port typically.

Now that I reread this...

The drug book does say that IV lopressor can be "given rapidly", though it didn't specify what "given rapidly" actually means...that said, unless I am doing our lopressor protocol (where I push the 5 mg over 30 seconds)...I typically push lopressor over a minute or so...I just didn't want you to think that "given rapidly" means over 2 seconds or anything...

You can also always check with your pharmacist if you have questions...And be sure to be aware of any standing policies or protocols that your hospital may have...