Diluting all IV push medication?? - page 4

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... Read More

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    Some antibiotics are very irritative to the veins ;augmentin ,cloxacillin etc .hence it is always wise to flush the iv site prior infusion ,dilute in 20mls ,then flush again.
    Gentamicin if given in the same line with these antibiotics may crystalise as well ,and always read the manufacturers guide before given any medications you are not familiar with.

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    I would like some clarification on giving IV medication through a port with a peripheral line infusing LR. A drug such as Zofran 4mg, given undiluted through a port with the IV running...the medbook states it can be given undiluted but given slowly ( I think it stated over 2 to 5 minutes). Do you give the med at the further port for greater dilution factor or give close to the hub and still flush before and after med? I don't see anyone pinching off the tube above the port prior to an IV push drug or stopping the pump if the solution is compatible....any feedback on this? What experience does anyone have with Reglan and a peripheral line? Returning Nurse to the floor....
  3. 0
    Quote from marty 08
    I would like some clarification on giving IV medication through a port with a peripheral line infusing LR. A drug such as Zofran 4mg, given undiluted through a port with the IV running...the medbook states it can be given undiluted but given slowly ( I think it stated over 2 to 5 minutes).

    Do you give the med at the further port for greater dilution factor or give close to the hub and still flush before and after med?
    I give zofran at either port. It isn't irritating, so it doesn't need to be diluted (but, you can dilute it if you want). If IVF are running, I let them continue to run while I push zofran. Now, if we're talking about different meds (other than zofran): If the medication is irritating or is strong (such as dilaudid), I dilute it and push it at the port that is the furthest away from the patient. If I'm running IVF to gravity, I will sometimes lock my syringe (with the medication drawn into it) to the port that is furthest away from the patient; then, I pull back on the plunger to draw the IVF into the syringe, therefore diluting the medication. Yes, flush before and after ALL your IVP meds.

    Quote from marty 08
    I don't see anyone pinching off the tube above the port prior to an IV push drug or stopping the pump if the solution is compatible....any feedback on this?
    I only pinch the tubing if it doesn't have an anti-reflux valve (some IV tubing will not allow you to back-flush). If someone is on IVF via pump, you can keep on pushing it while the pump is running (but only if the solutions are compatible).

    Quote from marty 08
    What experience does anyone have with Reglan and a peripheral line? Returning Nurse to the floor....
    Reglan can cause people to freak out REALLY bad. I dilute it, push it very VERY slow (longer than 2 minutes; more like 5). If someone does have a reaction to it (very anxious, "I'm going to jump out of my skin", ripping out their IV), then we give benadryl 50mg IVP. I've noticed its usually women in their 20's-30's who have problems with reglan. Oh yeah, don't give reglan if the patient has a bowel obstruction (it increases GI motility, which is bad if someone is obstructed).



    (this info may not be necessarily true for every IVP drug; some meds need to be given in a certain way, some are not compatible with certain IVFs; always look up a med before you give it if you are unfamiliar with how to administer it)
  4. 0
    We were taught, as a general rule, to dilute IVP meds in 10mL NS. We were also taught to use 10mL syringes for all IVPs. We were also taught to look up every med in our drug books prior to giving them, and to use the pharmacist as a resource.
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    Quote from kmoonshine
    Reglan can cause people to freak out REALLY bad. I dilute it, push it very VERY slow (longer than 2 minutes; more like 5). If someone does have a reaction to it (very anxious, "I'm going to jump out of my skin", ripping out their IV), then we give benadryl 50mg IVP. I've noticed its usually women in their 20's-30's who have problems with reglan. Oh yeah, don't give reglan if the patient has a bowel obstruction (it increases GI motility, which is bad if someone is obstructed).
    We dilute Reglan in a 10cc syringe, and run it as an IVPB over 20 minutes.
  6. 0
    Thank you all for your great information on diluting drugs for IV infusions. I am looking up all drugs that are routinely used on my floor for compatible solutions and if they need dilution. The information on the anti-reflux valve was great, the info on Reglan also is important. I will take the cautionary side if a drug seems to be possibly irritating, it would be prudent to dilute and give slowly.

    I am thinking that Reglan may be helpful to dilute, 10mg is in 2ml and CAN be given undiluted if not exceeded 10mg per my drug book....but it could not hurt to dilute with 8ml of NS and deliver slowly....I am concerned about the risk of extrapyramidal symptoms( is that the jumping out of your skin feeling??) that requires benadryl as stated in the IV drug manual. Do many of you routinely dilute Reglan for a 10mg dose? We have the premade 10cc NS syringes...it seems to me to first draw up the correct amount of the drug and add that to the premixed NS syringe after discarding 2ml NS. I will look up Benadryl....states may be given undiluted but in 25mg increments over one minute Any comments? Also, on the pre and post medciation flushes, my research indicates 2 or 3cc flushes used for IV push at the distal or proximal port? I am such a detail person!!
    Marty
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    Adenocard is one that is never, ever diluted. It's given as a rapid (like as fast as you possibly can) IVP followed by a fast NS 10cc flush. Adenocard's half-life is a few seconds, so you need to get it to the heart super fast and undiluted if it's going to do any good.
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    Quote from daisybaby
    Adenocard is one that is never, ever diluted. It's given as a rapid (like as fast as you possibly can) IVP followed by a fast NS 10cc flush. Adenocard's half-life is a few seconds, so you need to get it to the heart super fast and undiluted if it's going to do any good.
    Agree with the above. Also, valium shouldn't be diluted (although I think I stated that in an earlier post).

    Wanna know a secret?

    Davis' Drug Guide is available on PDA and IT IS AWESOME. You can look everything up really quickly (compatibility, route, side-effects, how to administer, etc). You can constantly update the information by "synching" your PDA, so all your info is current (and not outdated, like a book). It is my lifesaver, and I use it for everything.
    http://www.unboundmedicine.com/store...de_PDA_Unbound
    nurse grace RN likes this.
  9. 1
    I am a new graduate and I was never taught to dilute every single IV Push. We always looked whatever we were to give via push and gave it according to the drug book directions. Also as far as the Phenergan goes at my facility it must be diluted in at least a 50cc mini bag prior to administering.
    marty 08 likes this.
  10. 1
    Not all IV medications need to be diluted. The best practice is to look up the drug and follow the manufactures recommendation. Contrary to popular belief there are many drugs that are inherently irritating and no matter how much you dilute them ,it will make no difference in vein preservation or protection. Also be aware that there are a handful of drugs that can only be mixed with D5W.
    MAISY, RN-ER likes this.


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