Ativan IVP given undiluted into central line.

Specialties MICU

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Question: Can 1mg (0.5ml) of Ativan be given IVP undiluted into a central line if flushed before and after as you normally do for any drugs through central line port? Nothing was going in to Central Line.

I was with an ICU nurse this week ( I am a student) that did this and I asked her about it since most books say to give it diluted with equal amount of SW, D5W or NS. She says she does this with central lines but not IVs. I wouldn't give it myself paranoid of given administering a drug wrong, so she did it.

Is this okay or not?

Specializes in Surgery, Trauma, Medicine, Neuro ICU.

I usually dilute it with some Fentanyl if they're intubated/sedated. :saint: If I don't have something else I've giving it with, I usually dilute it with NS purely for ease of drawing it up into the syringe because it's so thick.

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Specializes in SICU.

I always use IVP Ativan cautiously in nonintubated pts. Some drs get very liberal with dosing(q 1-2 hrs) so if they are not intubated I weigh my options carefully, I personally prefer haldol, geodon or versed over ativan. However if they are intubated and not weaning I almost never dilute with NS.

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I always dilute in a 10mL flush...unless I need it fast for a buck-wild patient, and I have a MIV running, in which case I push it into the Y site.

As a student, or as a new nurse, or as a nurse anywhere other than ICU you should dilute and push each 0.5mg over a minute.

I think as a student you made the correct choice in not pushing it straight =)

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Specializes in Neuro ICU, SICU, MICU.

I work Neuro ICU and we most def. give it undiluted. Haven't had any issues with it before. However, as stated, every patient is different. Good advice guys. :) :cool:

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It all boils down to where you work and what your patient population is.

For a confused, intubated patient, thrashing about in the ICU bed, not listening to me telling him to stop reaching for his ET tube despite the wrist restraints (oh, they learn how to squirm down in the bed) :uhoh3: ... would I push Ativan undiluted into his central line to hopefully keep him from self extubating himself? ... you bet I would! :lol2:

Exactly the point another poster was trying to make; it is ALL about the circumstances. Which makes the entire

"I would do it but I'm not an ICU nurse" statement inane. If YOU are in such a situation, ALL you can rely on is experience versus knowledge.

Therefore, you had better KNOW your drugs, dosages, routes and side effects. Just because you have not done it before does not mean you should not know how. And I am ONLY speaking of things you SHOULD know in your practice. I'm not talking about a MS nurse knowing how to titrate Cardizem.

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Specializes in ICU-my whole life!!.
Frankly, I push undiluted Ativan into central lines all the time. I've never had any problems. The key, however, is to draw it up with an 18G needle.

X5k times! I did it last noc w/o issues:yeah::yeah::yeah::yeah::yeah::yeah::yeah:If it is a PIV, then it is diluted:up:

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Question: Can 1mg (0.5ml) of Ativan be given IVP undiluted into a central line if flushed before and after as you normally do for any drugs through central line port? Nothing was going in to Central Line.

I was with an ICU nurse this week ( I am a student) that did this and I asked her about it since most books say to give it diluted with equal amount of SW, D5W or NS. She says she does this with central lines but not IVs. I wouldn't give it myself paranoid of given administering a drug wrong, so she did it.

Is this okay or not?

I cannot imagine a situation that you need to give Ativan that also would not require running fluids.

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Specializes in Family Practice, Mental Health.
I cannot imagine a situation that you need to give Ativan that also would not require running fluids.

I can think of numerous situations, with pharmacy protocol blessings, in which it is imperative to give IV Ativan quickly into a PIV or a CL that has not had fluids running......but then again, I work in ICU and Trauma.

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Specializes in Cath Lab/ ICU.
I always use IVP Ativan cautiously in nonintubated pts. Some drs get very liberal with dosing(q 1-2 hrs) so if they are not intubated I weigh my options carefully, I personally prefer haldol, geodon or versed over ativan. However if they are intubated and not weaning I almost never dilute with NS.

Lol. I work with alcoholics. I can give up to 8mg an hr...every hour. Like, seriously, every freakin hour...

I call it the Ativan train. Once a pt gets on the train, he rides it for a few days. It's a tough few days...

Versed ain't worth didly squat in alcoholics. Of course, neither is Ativan. I'd rather give them a beer and save all the charting.

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I can think of numerous situations, with pharmacy protocol blessings, in which it is imperative to give IV Ativan quickly into a PIV or a CL that has not had fluids running......but then again, I work in ICU and Trauma.

If you work in ICU and trauma, then I would think that you would have a dedicated line with fluid that you can piggypack antibiotics, pain meds bood, etc into without disturbing your pressors, ntg, etc. I always strove for that.....was'nt always possible, but a rare occurence.

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Specializes in PICU, ICU, Transplant, Trauma, Surgical.

If central line, I give it undiluted, and as generally my pt is intubated I give it over maybe 30 seconds. As my pt is intubated, they are also on a fentanyl gtt, versed gtt and possibly propofol, vecuromium or ketamine gtt as well. I would of course have tried to bolus them off their gtt first, if unsuccessful, I'm giving the ativan and want effect NOW. I don't worry about the CNS depression as they already have an airway.

If the pt is NOT intubated, I would slow push it through the central line. Obviously if it's through a PIV, dilute it! As another poster stated it's viscous and probably doesn't feel great going through a peripheral....

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Specializes in Trauma/Critical Care.
Question: Can 1mg (0.5ml) of Ativan be given IVP undiluted into a central line if flushed before and after as you normally do for any drugs through central line port? Nothing was going in to Central Line.

I was with an ICU nurse this week ( I am a student) that did this and I asked her about it since most books say to give it diluted with equal amount of SW, D5W or NS. She says she does this with central lines but not IVs. I wouldn't give it myself paranoid of given administering a drug wrong, so she did it.

Is this okay or not?

Interesting...according to the drug manufacturer: " Immediately prior to intravenous use, ATIVAN Injection must be diluted with an equal volume of compatible solution. Contents should be mixed thoroughly by gently inverting the container repeatedly until a homogenous solution results. Do not shake vigorously, as this will result in air entrapment. When properly diluted, the drug may be injected directly into a vein or into the tubing of an existing intravenous infusion. The rate of injection should not exceed 2.0 mg per minute (http://www.globalrph.com/lorazepam_dilution.htm) "

To be sincere with you, I believe that in order to cover yourself, you need to be aware of what is considered standard of care. Personally, I would be concerned about the drug hitting the system too fast if given undiluted...

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