Diluting all IV push medication??

[srewer]

I had a nursing instructor tell a nursing student that "you must dilute all IV push medication with at least 10cc NS." I know that there are medication that must be diluted, but not all? I have not been able to find this standard in AL's nursing standards, just wanted to see if anyone knew of this being a nursing standard in your state and if so, where I could find information on the rationale. I think it could be a great implementation at my hospital, but first must find the evidence to back the idea. Thanks

[kukukajoo, LPN]

On a somewhat somber note and OT, an RN friend of mine had her contract terminated with an ER because she diluted phenergan for IVP! Talk about trumped up.....

Are you sure there is NOT more to this story?

I don't have my IV drug guide in front of me to check out recommendations but from a pt standpoint, Phenergan is very very caustic to veins. When I was in for my lung abcess I had to have a PICC line inserted as the IVs became single use d/t Phenergan. They ran out of places to start one and finally I asked for the picc line to save my poor veins. I left the hospital looking like a junkie I had so many bruises on my arms that stayed FOREVER as some formed cording clots and jeez those suckers take at least a month to dissolve.

[nathan04]

How about 50 ml. Sodium Bicarbonate? What I have observed, it has to be given straight IV push in a 50ml. syringe esp. during emergencies, but when I started to work overseas, the practice there was it should be diluted with N/S in an IV drip.

Which is which?:angryfire

[al7139, ASN, RN]

Does no-one use their hospital pharmacists? If the dilution instructions are not included on the MAR part of my worksheet, I will call and speak to a pharmacist to be sure of things like dilution, push rate, and compatibility. Drug books are good, but don't always give you the answers, especially if it's a new drug. Usually, I have found that the pharmacists have better knowledge and resources to get this info. At our hospital, they are very helpful, and will tell me what I need to know. Also they can tell you what is compatible. For example, I had a pt last night who had a heparin gtt as the main line, with D5 NS with 40mEq of KCl at 75cc/hr. I needed to give Zosyn to this pt. I called my pharmacist to ask about compatibility, and if it was safe to piggy back the Zosyn, or did I need to use another line. They were very helpful, and yes, all 3 solutions were compatible. Your pharmacy is an invaluable resource.

And, as for the original post; anyone who says all IV push meds must be diluted is wrong.

Amy

[mianders, RN]

Your nursing instructor is wrong, not all meds should be diluted. Any time you have not given a med before it is ALWAYS prudent to look it up.

[Tolos]

My drug book says of Benadryl" GIVE IV UNDILUTED 25MG/MIN" may be diluted with 0.9% NaCL and some other compatible fluids. So yes nursing discretion matters with this and other IVP med admin. Extra fluids of about 5 -10cc can still be diurised by lasix. :redpinkhe

[RNforLongTime]

I've never diluted MOST of the drugs that I've given IVP over my career. I DO dilute ativan and phenergan---which we rarely if EVER give IVP anymore. I do try to give the drug through a main IV line, if the pt has one.

When in doubt always check your hospital policy....no matter WHAT you were taught or not taught in nursing school.

[New2ED]

On a somewhat somber note and OT, an RN friend of mine had her contract terminated with an ER because she diluted phenergan for IVP! Talk about trumped up.....

Sounds like there is more to this story!!??!! Phenergan is one of those that I always dilute in order to save a vein and so it doesn't burn the crap out of my pt. I have seen a few hospitals that have P&P requiring you to dilute phenergan due to the 25mg/1mL. Maybe this "friend" omitted part of the story.

[meandragonbrett]

I typically dilute meds if they are going in a PIV. When I have a double lumen cordis, I hardly ever dilute .

[icurudyrn]

I have been an ICU/ER nurse for 15 years and I always dilute my IVP meds with NS. Protocal is to flush with NS before and after so if you think about it there is no difference in diluting the med if it is compatible. I have seen patients almost loose limbs due to nurses not diluting push meds. When you dilute the risk of phlebitis is less with less pain at site.

[srewer]

Just want to thank everyone for their replies and advice. My manager and I were actually looking on the internet for some time trying to find a recourse that stated this policy, but I decided to ask everyone here what they thought.

:cheers:THANK YOU:cheers:

[UM Review RN, ASN, RN]

I misread the question. There are very few IV antibiotics I would push straight. But, yes there are many other drugs you can push without having to dilute them. I always check with policy and manufacturer guidelines (MIMs we call it here).

I don't know of any IV antibiotics that we push here; they're given via intermittant infusion.

Interesting how other countries do things differently, isn't it?

[MAISY, RN-ER, BSN, RN]

In our hospital we push 1 gram/10ml Rocephin ivp...used very often in our ER. Only push antibiotic I am aware of, although our ER pharmacist insists others can be pushed...we just don't do it.

Maisy;)