IV push ativan...please help this student!:)

[sweetieann]

This sounds kind of stupid (I know, I know--there are no stupid questions...only stupid people =X), but I was just wondering:

Say you were ordered to give a small dose of IV push Ativan (say 2 mg and it was supplied as 2mg/ml in the vial). So, you decided to add some NSS to the vial so it is easier to draw up the tiny 1ml. Here is my question: Would you just lower the plunger to 1ml, inject into the NSS and then draw back 1ml NSS and then inject that right into the vial of ativan? OR...would you have to first push air into the Ativan bottle to break the vacum (or would injecting the 1ml of NSS into the Ativan bottle break the vacum?) Basically, I am concerned with the air bubble issues.

OK, that might have sounded confusing. So basically, is doing this ok:

1)Pull back syringe 1ml and inject that 1ml of air into the NSS vial.

2)Invert needle and pull back 1 ml of actual NSS.

3)Take needle and inject 1 ml NSS into Ativan bottle.

4)Draw back med (all of it, since it is ordered 2 mg/ml and that's what is in the bottle).

THANKS SO MUCH for help with this silly question =P

[rgroyer1RNBSN, BSN, RN]

:angryfire Always Dilute all Viscous Medications!

I always take one of those 10 ML prefilled NS flush syringes waste about 1/1.5 of the NS then take your 3 ML syringe and an 18 G Needle and draw up the ativan then invert the syringe of NS and put the ativan with the saline and go push it or you can be like one of my colleagues who blows the tops off stuff all the time, or another one who uses 20 ML syringe with 18 Mls of NS to dilute it.

:balloons: Hope that helped Rod RN[bANANA][/bANANA]

[Noryn]

Wow all you guys that dilute it, is there some literature to back that up or is it just personal preference? In all the places I have worked we have never diluted it. I havent given Ativan push though in probably 4-5 years. I never had a problem with it, the biggest problem at our hospital though was on the floor some nurse would always give it to a 60 or 70 year old then the next thing you know they had to call a code. I mean this was really common enough to make me feel very uncomfortable which I talked to my clinical manager about but like it did any good.

Be very careful with it regardless but I still have never diluted it and didnt really have a hard time pushing it--it was much easier than those dang amp of D50s.

[Gompers, BSN, RN]

We don't dilute it either, and I work in the NICU. Many of our meds have to be more dilute than what you give to older kids or adults, but even we don't dilute the Ativan. We give the 2mg/ml concentration, and while it's thicker than most meds, it's NOT like pancake syrup. (I once had to give a testosterone shot when I was in nursing school - now THAT stuff was thick!!!) We have no problems giving it without diluting. Just use a 3cc syringe, or a 1cc if the dose is 2mg or less.

For meds that we do dilute, and we do this very often - we never add more fluid to the medication vial. We'll draw up our normal saline or sterile water (depending on med) into one syringe, then use another syringe to draw up the medication from its vial. Pull back the plunger on the syringe with the saline/water to make room, take off the needle, then insert the needle from the syringe with the med into the hole at the top of the other syringe, and squirt it in to mix with the saline/water. Put the administration needle on top of that, roll it around to mix it up, and then push out the air.

[NP2BE]

I wouldn't use saline at all. Why dliute it? I would jsut use a smaller syringe to draw it up. Use a 3 cc syringe and draw up the Ativan itself, no saline. Thats how I've always done it and I've given Ativan alot!

Just because You have always done something a certain way doesnt mean its right. Its the one time that it can hurt someone we are concerned about. And pushing undiluted ativan is not recomended by anyone, most importantly the maufacturer which is what you would be facing in court

[NP2BE]

Wow all you guys that dilute it, is there some literature to back that up or is it just personal preference?

Yes, as a matter of fact the iv drug guides , all that i have read as well as the manufacturer's insert (which is what hold up in court)

[beautifulb]

I can't recall what the strength is of our pre-filled Ativan syringes (maybe some are a total of 5mg or 2mg) are but I know that frequently we need to waste with another nurse. I take a five cc syring and put an 18g needle on the end and draw up the entire amount of Ativan in front of the other nurse and waste the unneeded amount. In that same syringe, I draw all of the Ativan to the back of the syringe. Instill some air into the NS vial and take maybe 3ccs of saline. I then change the needle to a blunt cannula and I make sure to agitate the syringe of Ativan and saline. And, voila, good to go.

I honestly can't recall if the IV drug book states to mix it with saline or just leave it be, but to me it just seems like the push would be easier to go in and be slightly more friendly to the IV site. Thank You for allowing my 2 cents!:roll

[UM Review RN, ASN, RN]

Our Ativan comes in 2mg/ml vials (the kind you do have to put air into). We often get orders for 0.5 mg or less, which is a pain in the butt to draw up with a 3 cc syringe, so I often will use a 1 cc syringe and dilute with NS.

For those of you who don't dilute, this is the latest info I could find. Techniques are always changing and it's good to keep up with the newest stuff.

From Davis's Drug Guide:

http://www.drugguide.com/monograph_library/psychotropic_drugs/lorazepam.htm

Direct IV: Dilute immediately before use with an equal amount of sterile water, D5W, or 0.9% NaCl for injection. Do not use if solution is colored or contains a precipitate.