What do you draw up first? LR or Demerol

Are you using demerol vials or carpujects?

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.

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).

We never hang it, we inject it IM or sbq

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.

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).