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

  1. 0
    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

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  2. 18 Comments...

  3. 0
    you could if it will all fit in the bottle.
  4. 0
    Quote from sweetie715
    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).
    First of all, your last point should be accurate, but isn't. Because the bottle says it has a set amount in it does not mean you can pull it all up. Most vials of meds are slightly overfilled. You need to pull all of your ativan (or any other med) into your syringe first so you can measure it exactly.

    I never inject air into those tiny 2ml vials--they don't hold that much and never need it--you will end up spraying yourself with lots of drugs if you continue to do that.

    In the case of diluting ativan here is what I do: Grab a 5 or 10cc syringe, fill it with the proper dose of ativan, grab a vial of NS, pull back a lot of saline and continue to pull as I am removing the needle from the vial. you will have created a vaccum in the NS, but that's ok, I then throw that away. It is contaminated with ativan and I don't want to inadvertently give that NS to anyone else. I'm sure others do it differently, but this is what I've found works for me.
  5. 0
    Yeah...with ativan and those tiny bottles, I get a 10 cc syringe (that is a common one in my hospital prefilled with NS), push out a cc or two and set it aside for a moment capped. Then I draw up and measure with a 3 cc syringe my medication. Then I put it into the 10 cc NS syringe and I am good to go! My facility is almost totally needleless, so this seems to be a great way to do this with just one needle (since I never put a needle on the 10 cc, only the one I use for measuring the medication during draw).

    Slow IV push .
  6. 0
    I fill the syringe with 9.5 ml NSS, then I pull back to the 10ml point, push the .5ml air into the vial of ativan and fill to 10ml.

    Then I withdraw the needle, dispose of it according to hospital policy - then I get rid of the air and cap it.

    I know someone already posted this but it can't be said enough: slow push. You will get a patient population that is accustomed to the push (I'm talking oncology patients, not "seekers") and they tolerate the pushing well. If I get a newly diagnosed patient on induction chemo, I hang that ativan in a 50cc bag and I run it over 15 minutes.

    You'll figure out what works best for you. I work with a few nurses who don't dilute anything and have excellent control pushing a .5cc syringe full of ativan over three minutes. I'm still a newbie, so I'll do 10cc's and watch the clock!!

    Blee
  7. 0
    NEVER inject air into a Tubex, which is how our Ativan, Demerol and most of our Morphine comes! I guess I had to learn the hard way.

    We have prefilled 10 cc syringes and I let out 3 cc's of NS then I put on a blunt fill needle and draw up the Ativan from the Tubex and push the whole 8 cc's SLOWLY! I work on an Oncology and BMT floor so almost ALL of my patients are accustomed to IV push meds.

    Carlissa
  8. 0
    Quote from MrsStraty
    NEVER inject air into a Tubex, which is how our Ativan, Demerol and most of our Morphine comes! I guess I had to learn the hard way.
    What? You don't think it's fun to blow out the end of the tube and spray morphine over everything within five feet?

    The real embarrassment comes when you have to find someone to co-sign the wastage. "Yeah - that's 10mg of morphine running down the wall. Just sign it, will you?"
  9. 0
    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!
  10. 0
    Quote from Crocuta
    What? You don't think it's fun to blow out the end of the tube and spray morphine over everything within five feet?

    The real embarrassment comes when you have to find someone to co-sign the wastage. "Yeah - that's 10mg of morphine running down the wall. Just sign it, will you?"
    I've done that ... won't do it again. :spin:

    As the last poster said, I do not dilute Ativan. I just use a 3mL syringe. And I give a lot of Ativan IV, and occasionally some IM for a patient who needs to be made more comfortable before we can start a line.
  11. 1
    Quote from MommyandRN
    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!
    I have always diluted IV ativan (and it looks like most other folks here do too) because it is so viscous. It has the consistency of pancake syrup. And then if you dilute it in a 10 ml prefilled syringed of saline, it is easier to push it over a couple of minutes.

    :spin:
    minnib likes this.


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