Dilute IV meds or not?

Nurses General Nursing

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Specializes in Transplant, homecare, hospice.

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?

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Specializes in ER, NICU, NSY and some other stuff.

I dilute anything if there are no contraindications. (ie: med incompatible with dilutent, fluid restriction) Now this said I am assuming that you are referringto an adult population, for neonates I do dilute but ONLY to what the Neofax reccomends.

Especially if it is to be given through a PIV. Nearly everything that you give is going to be very alkalotic or acidotic, hence why it burns. I find this is more comfortable for the patient. It is also easier to give something slowly if it is diluted to a larger volume than say 0.5 or 1 cc.

This is what I do. Anyone else?

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

It really just depends on the drug. Some drugs do not need to be diluted (like lopressor). You have to be careful with the amount you dilute with, also. Some drugs ( I can't think of any off hand) must be diluted with only certain amounts, no more. I always just look it up, and do what the book recommends. Most of my patients have running fluids, so it's not an issue usually.

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phenergine and ativan. I always dilute them. If the situation allows I like to hang a tko n/s. That way you can give phenergine in the high port...I push a little, pull back a little, push a little...

Phenergine can be nasty on viens...ALWAYS dilute it. Ativan is oily and thick and if you are only giving a little it can be hard to push it slow.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

For saline locks, I dilute everything unless there is a specific reason NOT to.

For IV lines, I just put the med in at a HIGH port-----most do well this way. We are not permitted to give Phenergan IV, thankfully. That is the one I saw most problems with when we did.

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Specializes in cardiac/critical care/ informatics.

I don't dilute unless it is recommended, NS burns some patients, so I don't see the benifet of diluting everything. Some medications won't work as well if you dilute, such as adenisone, of course that is given in an emergent situation and you wouldn't take the time. :)

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Specializes in Transplant, homecare, hospice.
For saline locks, I dilute everything unless there is a specific reason NOT to.

For IV lines, I just put the med in at a HIGH port-----most do well this way. We are not permitted to give Phenergan IV, thankfully. That is the one I saw most problems with when we did.

Hi. Thank you for your response. What do you mean by a HIGH port? You mean like a high volume port? They are usually on the PICC's...The red one...Or do you mean like an 18 or 20 gauage INT?

We give Phenergan from time to time. Not very often. The MDs like to use zofran, but zofran doesn't work with some...

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I only dilute if it calls for dilution. We give phenergan all the time and I've never had a problem with it.

The high port is the IV access port high up on the tubing, above the IV pump. The problem with that is I have to take the tubing out of the pump, which, with our "new" and "better" pumps:rolleyes: takes a bit of time. If I try to access the port with the tubing still in the pump, the pump senses "upstream occlusion" and stops. :rolleyes:

I miss our old pumps - sometimes technology doesn't save time and adds frustration. :)

steph

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Specializes in Transplant, homecare, hospice.
It really just depends on the drug. Some drugs do not need to be diluted (like lopressor). You have to be careful with the amount you dilute with, also. Some drugs ( I can't think of any off hand) must be diluted with only certain amounts, no more. I always just look it up, and do what the book recommends. Most of my patients have running fluids, so it's not an issue usually.

The nurse I followed said she was diluting with 5:2...meaning 5ml lopressor to 2ml NS. I did the same thing. I was concerned mainly because the lopressor was working so quickly, even tho I was pushing it in over 5 minutes. After slowly flushing the line...the patient's V-Tach with occasional PAC's went from 135 to 100 to 80 to mid 70's in a matter of minutes. It scared me at first and I wouldn't leave his room just glaring at the machine.

:rolleyes: The pt was like, "is everything okay?" I told him he was fine, I just wanted to watch his rhythm...and retook his irregular blood pressure.

The MD was telling me that Lopressor is quick and short acting. It is in and out of the system quick. It sure was, by the time the next dose was due (6 hours later), he was back in V-Tach!

I was so worried because this guy had a hx of A-fib and I was praying to *G* all night...saying, "please...not tonight. Not ever...no no no."

Thanks for everyone's responses....I love learning new things!

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Specializes in Transplant, homecare, hospice.
I only dilute if it calls for dilution. We give phenergan all the time and I've never had a problem with it.

The high port is the IV access port high up on the tubing, above the IV pump. The problem with that is I have to take the tubing out of the pump, which, with our "new" and "better" pumps:rolleyes: takes a bit of time. If I try to access the port with the tubing still in the pump, the pump senses "upstream occlusion" and stops. :rolleyes:

I miss our old pumps - sometimes technology doesn't save time and adds frustration. :)

steph

Oh, okay....yeah...We use Alaris pumps. Thanks for the reply. I feel a bit better now. :)

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my hospital uses syringe pumps.so whether it;s lopressor,lasix or bumex,you can give it full strength via a kvo line.[in icu we never have a pt without at least a kvo.].but when i do oncology i call the pharmacy and ask for minimal and maximum dilution if any is needed.with the exception of adenosine and very few other drugs almost any med can go in a 10cc syringe pump and be run slowly over 5-15 minutes.an aside to the phenergan issue;it has been one of the most side effect producing drugs i have used in my dozen yrs in oncology and icu....yes it works better and faster than most antiemetics but it;s lethergy s.e. can be potent.family members have run out to the nurses station on as little as 12.5mg ivpb to let a nurse know that mom or dad is very "sleepy" or hard to arouse.it also can cause hypotension....

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I only dilute if it calls for dilution. We give phenergan all the time and I've never had a problem with it.

The high port is the IV access port high up on the tubing, above the IV pump. The problem with that is I have to take the tubing out of the pump, which, with our "new" and "better" pumps:rolleyes: takes a bit of time. If I try to access the port with the tubing still in the pump, the pump senses "upstream occlusion" and stops. :rolleyes:

I miss our old pumps - sometimes technology doesn't save time and adds frustration. :)

steph

Be careful of this...We had a kid OD on morphine cause the nurse before didn't flush the med all the way through and when the new nurse came on and gave more morphine the kid got a double dose.....nursing standard is you give the meds closest to thepatient to advoid a overdose!

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