What do you draw up first? LR or Demerol

1. I found some info similar to my question but I would like to clarify and/or seek advice on my situation. I work in an ambulatory surgery center and doesn't have NS vial or pre-filled NS syringe to dilute.
   
   Therefore, when I need to dilute Demerol, I usually draw up LR first from the beg which is running on the patient then, I change the needle to filter needle and draw up the Demerol.
   
   Is this accurate or it doesn't matter?
   
   My rational for drawing LR first is that I'm afraid Demerol could by chance get into LR beg. Am I thinking way too much? Advice please. Thanks!!

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2. 9 Comments

   Comment
3. 
   Sep 19, '13

   Are you using demerol vials or carpujects?
4. 
   Sep 19, '13

   Ampule
5. 
   Sep 19, '13

   Obviously first of all, be aware of your policies, but in general demerol doesn't require dilution. The FDA labeling does suggest dilution as a way of ensuring a slow infusion, although the same effect can be achieved by using a smaller volume syringe since the purpose of dilution for this reason is that there is a higher ratio of plunger movement to dose given. If you're pulling LR from a bag of running fluids, then infusing it into the same IV, you're sort of taking an extra unnecessary step since you could also dilute it to the same degree by pushing it slowly into the line.
   
   But yes, I'd agree that if you're going to pull fluids from the bag to dilute then you should pull the fluids first, then the drug.
6. 
   Sep 19, '13

   Thanks MunoRN!
7. 
   Sep 21, '13

   I always dilute the Demerol, dose not matter if I'm giving it with an existing iv running or through a int. rationale is I've had iv Demerol before and it burned like fire up my arm. I dilute the Demerol in the syringe and turn the ivfs wide open for a few seconds (if feasible).
8. 
   Sep 21, '13

   We never hang it, we inject it IM or sbq
9. 
   Sep 22, '13

   I always dilute Demerol. Didn't know it burned. Thanks Z71RN.
10. 
    Sep 22, '13

    I've always given it through the IV, but dilute it by pinching off the IVand pull from the bag if that makes sense then inject slowly(so rather than drawing directly from the bag I draw directly from the line and then push.
11. 
    Sep 22, '13

    To get the most accuracy in pulling up the narc, I'd draw it in the smallest possible syringe and then inject it into a larger syringe that already has the fluid in it (most easily done with prefilled flushes but fine to pull it from a bag).

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