Okay, Dumb question=Diluting meds - page 2

The threads about diluting phenergren and nexium reminded me. I want some tips. For instance, if you give 12.5 of phenergren, the vial is 1 ml = 25 so you have to pull 1/2 a ml. We use... Read More

  1. by   sonja77
    here's what i do:
    i use a 3ml syringe and draw up 0.5ml of phenergan into that syringe with a blunt "fill needle". then i squirt 0.5ml of ns out of a prefilled 10ml saline flush and after that i squirt the phenergan into the saline flush.
  2. by   NicoleRN07
    When I dilute Phenergan, I draw up 9ml of NS, and the 1ml of Phenergan (25mg/1ml) to equal 10ml. If my order is for 12.5mg, then I waste 5ml. If my order is for 6.25mg, then I waste 7.5ml. If you make it even, it makes it much easier. Same thing with Morphine. Our Morphine comes 10mg/1ml, so I draw up 9ml NS, and the 1ml of Morphine making my dilution 1mg/1ml.
  3. by   Fairlythere
    Yeah, we have 3 ml. Its just that my brain couldnt figure out how to get it into a prefilled 10 cc syringe without losing some of it cause I was too thick headed to think of using a REAL needle rather than a blunt plastic one. DOY!

    Its interesting to see how many people do things differently though.
  4. by   nursemike
    Quote from Fairlythere
    I know how much I NEED, problem is I cannot accurately measure .5 of a 1 cc vial in a 10 cc syringe, as another poster pointed out, the measurements are in increments of 2, 4, 6, etc. Could do 1 cc because there is a mark.

    Anyway, I like Tazzi's suggestion, I forget about using a sharps needle to inject into a larger syringe hole. Always using those plastic things, you forget about sharps LOL.
    In my carpenter days, I could routinely measure a board to about 1/16th of an inch, even though my measuring tape was graduated in 1/8ths, simply by going between two marks. If your dose is between .4 and .6 mls, it's almost certainly close enough. How else could the same dose be okay for a 60kg pt and a 100 kg patient?
    On the other hand, Tazzi's plan would assure even greater accuracy.
    You could probably confirm whether my assumption is valid by a call to your pharmacy. Hmm. I may just give mine a buzz, tonight.

    I see it done a lot, but I really don't like to put meds into a prefilled dilutent. I'd rather put the dilutent into a plain syringe, and unless I'm actually at the bedside, I label it.
    Labelling is a nuisance, but one time of getting called away from the med cart and having to re-draw the med because I couldn't be absolutely certain I was picking up the same syringe was enough to convince me.
    Last edit by nursemike on Feb 28, '07
  5. by   SweetOldWorld
    Quote from obrnheather
    Draw up your NS, say in a 10ml syringe you would draw up 9mls NS then 1ml of phenergan 25mg/ml. If you were to give 12.5 mg, then just push 5ml of the diluted med and waste the rest or label it and put it in the patients med drawer for another dose later. I know with phenergan we want it more diluted than that, but the same principle applies.
    For those of you using this method, how do you ensure the drug is thoroughly mixed so that when you administer half, you are actually giving an accurate dose of the drug?

    I prefer to draw up the exact dosage of drug in a 3 ml syringe, and then dilute with NS in a 10 ml syringe. That way I am confident I am giving the proper dosage.
  6. by   RoxanRN
    Quote from SweetOldWorld
    For those of you using this method, how do you ensure the drug is thoroughly mixed so that when you administer half, you are actually giving an accurate dose of the drug?
    After you've gotten your drug and dilutant into the same syringe, aspirate an additional 1-3ml of air to the syringe. Invert several times. I don't think you can mix it any more thorough. After mixing, tap out any remaining air bubbles and push out the air. Now you're ready for injection into the port of choice.
  7. by   all4schwa
    what's wrong with drawing up the med accurately, and then drawing up ns to fill the syringe?
  8. by   marty 08
    I understand diluting phenergan. WithToradol, if the order is 15mg, and it is 30mg in 1ml vial, draw up .5ml for 15mg in a 3cc syringe for needleless port. The medbook states it may be given undiluted and administer through a free-flowing IV or through three way stopcock or y-tube . It CAN form a precipitate with drugs incompatible such as demerol, morphine and phenergan, so it seems very important it pre and post flush. Rate of administration recommended is a single dose over 1-2 minutes prefered. I would think the running IV fluid(if compatible) will also help dilute? So, this is what I get from looking up in the medbook for administration....Would love to hear the concensus out there on the floor and your hospital policy to dilute Toradol? We are now very careful to limit the amount of maximum Toradol daily due to it's NSAID property. This analgesic (non-steroidal anti-inflammatory) works really well when alternated with a narcotic for pain relief. Marty
  9. by   northshore08
    I have not heard of anyone diluting Toradol; and you are right about making sure you flush well between meds. Have not had any complaints, but I do not put IVs in the hand unless it is the last resort.

    I'm glad this is an old thread--one of our docs likes to give 10mg of Toradol; that would drive the OP crazy! And when I moved jobs recently, they were still using IM Toradol (the 60mg/2ml vial) for the IV route. It took one phone call and a couple of days later, a new IV Toradol was available in the Pyxis!
  10. by   marty 08
    Thanks Northshore
    I read an old thread that stated someone always diluted Toradol at their hospital? I also do not see Toradol routinely diluted but wondered what the best practice was?? Many nurses routinely dilute drugs in 10cc NS and others follow the IV drug books administration guide if determined safe to deliver undiluted with infusing IV but with specific duration. I am routinely checking with the IV book on the floor to confirm which drugs can be given undiluted. Thanks for the reminder regarding IM Toradol and to check carefully for IV medication route on vial... very true!!
    Marty
  11. by   marty 08
    Dear Northshore
    How are you administering Reglan IV push? I am cautious with this drug due to side effects. I know my friend from the ER has physician orders for IVPB infusions. What is your practice in diluting and giving this medication slowing IV push. Marty
  12. by   Misty1334
    Maybe this is a dumb ques too, but I thought this was a good place to ask. During my preceptorship (for school) in the Trauma ICU, my preceptor first of all told me "if the pts alive push e/t slow, and if they're dying push fast", well I obviously know that there's more of a science to pushing meds than this - but my question is, I'm getting ready to go to the ED c a new Preceptor, and I'm wondering what's the best pckt ref. I can get to for IV meds - to find out how fast I should be pushing, compatibilities, etc.

    Also,
    When I administered Phenytoin, Dilaudid etc via an infusing port he never told me to Dilute them, only to Pre/Post flush.... is this correct? He also confused me even more bc he also said many other times, that if I'm running NS I don't need to flush - so what is the Criteria for when to flush, when to dilute etc while infusing NS?

    Even when 3/5/10ml NS would appear as a maintenance, he would tell me to just scan them in, that we didn't need to admin them if there was NS running.... I get the reason behind maintenance flushes, but I can also see his point that the NS already running - I just wonder why they would appear as sched if I don't hv to admin them? Maybe he's right, but I noticed him doing some pretty lazy/shady things as time went on, and I don't want to go into the next rotation with these bad habits!

    I just don't understand how on such a busy floor as this was, a new RN could ever have the time to look-up everything. Many times when I would ask spec. quests about drugs - flushing - etc. the RNs were clueless, they just knew the way that had "always done it", but had no real reason behind it...

    Thanks for your help! I've learned so much from you guys!
    Sorry for the Novel!
    - misty

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