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... Read More

  1. Visit  iluvivt profile page
    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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  3. Visit  dialysispt profile page
    0
    I go to dialysis and often receive benadryl. Should it be diluted? Some nurses do and others don't. I feel like it does not work as well when it has been diluted. I thank you in advance for your time.
  4. Visit  dialysispt profile page
    0
    You mentioned that you use benadryl for patience that feel like they want to jump out of their skin. I get that feeling when I am on the dialysis machine. Because of this feeling, I am given benadryl. When it is administered, some nurses dilute it while others do not. I wonder if it should be diluted. I know it does not feel like it is working well when it is diluted compared to when it isn't diluted. So, should it be diluted? I thank you in advance for your time.
  5. Visit  LouisVRN profile page
    0
    I dilute almost all of the medications I give IV. Except for Valium, as another poster mentioned and anything needing to be given STAT, like Ativan in a pt that is seizing. I find that a lot of time people won't feel as immediate effects of medications like Benadryl, Dilaudid, Morphine when they are diluted but they also seem to have less adverse effects, drop in BP, Pulse, Respiration etc. regardless of whether or not they "like it" I do dilute it, they are getting the same dose.
  6. Visit  LouisVRN profile page
    0
    I will never give anything in a port that is not closest to the patient with the exception of possibly a central line. Just in case it is something like Dilaudid and at some point between you injecting it and the patient believing the dose was delivered the line blows.
  7. Visit  mykrosphere profile page
    0
    the only drugs i have ever diluted are protonix (which pharm specifically states to mix with 10 ml of ns) and ativan for im injection (because man that hurts!)

    if a drug needs to be diluted, it is usually done so and hung as a piggyback.
    100 percent of our antibiotics are hung piggyback.
    and 99 percent of our patient population has a picc or central line.

    i have never had an issue with not diluting.
    but i have heard plenty of complaints about the taste of a saline flush (??)
  8. Visit  mykrosphere profile page
    0
    Quote from dialysispt
    I go to dialysis and often receive benadryl. Should it be diluted? Some nurses do and others don't. I feel like it does not work as well when it has been diluted. I thank you in advance for your time.
    i used to work in dialysis and have never heard of benadryl being given diluted through a line.
  9. Visit  K+MgSO4 profile page
    1
    Paracoxib(dynstat) is a fast IV push and ceftriaxone can be given in 10 ml water push.

    Here in Australia we don't get our IVABs pre mixed so it is up to the nurse to read the Australian Drugs handbook to check how each and every IV drug is given.

    Also check hospital and ward policy. In ED nurses can push IV morphine but on the wards it has to be given s/c
    carolmaccas66 likes this.
  10. Visit  krazievi3t6url profile page
    0
    funny, I found this questions.
    I was told by an ER nurse today that you can't dilute valium and any code meds! Maybe that is the policy and procedure at that particular hospital, not sure though.
  11. Visit  synergy89 profile page
    0
    Is diluting pain or cardiac medications even evidenced-based? Or just nurses being too worried? As long as you push at the correct rate and then flush at the same rate of the drug I see no need in diluting. People diluting phenergan to make it less irritating on the veins is not evidenced-based either from what I've read the pH does not change despite adding a few cc's of saline. It's going to irritate the vein regardless. Although it is good practice to administer in an already infusing line to reduce the likelihood of extravasation. Do you really think that extra 2-9 cc's of saline is going to make a world of difference when it's dumped into 5-6L of blood?
  12. Visit  notjustanurse profile page
    1
    Quote from synergy89
    Is diluting pain or cardiac medications even evidenced-based? Or just nurses being too worried? As long as you push at the correct rate and then flush at the same rate of the drug I see no need in diluting. People diluting phenergan to make it less irritating on the veins is not evidenced-based either from what I've read the pH does not change despite adding a few cc's of saline. It's going to irritate the vein regardless. Although it is good practice to administer in an already infusing line to reduce the likelihood of extravasation. Do you really think that extra 2-9 cc's of saline is going to make a world of difference when it's dumped into 5-6L of blood?

    The Institute for Safe Medication Practices suggests that "...further dilution of the 25 mg/mL strength [promethazine] to reduce vesicant effects and enable slow administration. For example, dilute the drug in 10 to 20 mL of normal saline if it will be administered via a running IV, or prepare the medication in minibags containing normal saline if there is time for pharmacy to dispense them as needed for individual patients. (Trissel confirms that promethazine is physically compatible when diluted in normal saline, with little or no drug loss in 24 hours at 21 degrees C in the dark, when prepared in glass, PVC, and polyethylene-lined laminated containers [Handbook on Injectable Drugs, 13th edition. ASHP, Bethesda, MD; 2005:1266].) Extravasation can also be recognized more quickly when promethazine is diluted than if the drug is given in a smaller volume."

    So, yes, I think it is pretty much universally accepted that you SHOULD dilute phenergan. Honestly, would you like to receive it undiluted?
    zzravizz likes this.
  13. Visit  notjustanurse profile page
    0
    You can find the entire article I quoted here: http://www.ismp.org/newsletters/acut...s/20060810.asp
  14. Visit  synergy89 profile page
    0
    Phenergan's pH is 4.0. A 10-fold dilution will result in a negligible change in the pH ( ~+ 0.3). NaCl is the salt of a strong acid and strong base and has a neutral pH. Promethazine is considered a weak acid and is only partially dissociated in solution. The degree of dissociation is proportional to its Ka (dissociation constant). Larger Ka --> stronger acid (greater dissociation). The pH of promethazine after a 10-fold dilution (or greater) is still quite low. So it's still going to irritate the veins to a great degree. Of course I always dilute it per hospital policy but as you can see diluting does little to no help in patient comfort as the pH remains the same. I was mainly targeting the individuals who believe all opioid analgesics or cardiac meds should be diluted.


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