Ativan IVP given undiluted into central line.

  1. 0 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?
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  3. Visit  Septic Boy profile page

    About Septic Boy

    Joined Sep '05; Posts: 7.

    36 Comments so far...

  4. Visit  VivaLasViejas profile page
    8
    I myself have never given IV Ativan without diluting it in at least an equal amount of NS......the solution is very thick and viscous, and pushing it undiluted---especially with a 2 ml syringe---could create too much pressure, not to mention enter the circulation too fast and cause speed shock.

    That said, ICU nurses generally have more leeway as to what they can and cannot do, since they often have to act quickly and decisively in order to respond to rapid changes in a patient's condition. I've worked ICU in the past, and I have a healthy respect for what those nurses do every day, even though I'd be uncomfortable doing some of those things myself. I've had some pretty critical patients who were alert and talking one minute, and then lost consciousness and turned gray right in front of my eyes; at that point, you don't worry about technique, you get the necessary meds in and you do it FAST, or you can lose them.

    You see, there's school, there's tests, and then there's real life..........it takes time to learn how to differentiate between them and accord each their proper place. Good luck to you in your nursing education and career.
  5. Visit  suzanne4 profile page
    0
    I always add saline to it before even trying to draw it up, much easier that way. Especially if you need to give it in a hurry. But is it required? No.
  6. Visit  pricklypear profile page
    0
    Good question!

    If I'm giving it into a saline lock (no fluids running) I dilute it with an equal amount of NS. But I'm usually giving it to folks with running IVs and just push it slowly undiluted (as it gets diluted in the line) as long as the fluid running is something without a lot of other stuff added.
  7. Visit  versed88 profile page
    9
    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.
  8. Visit  GoNightingale profile page
    0
    Quote from VivaLasViejas
    I myself have never given IV Ativan without diluting it in at least an equal amount of NS......the solution is very thick and viscous, and pushing it undiluted---especially with a 2 ml syringe---could create too much pressure, not to mention enter the circulation too fast and cause speed shock.

    That said, ICU nurses generally have more leeway as to what they can and cannot do, since they often have to act quickly and decisively in order to respond to rapid changes in a patient's condition. I've worked ICU in the past, and I have a healthy respect for what those nurses do every day, even though I'd be uncomfortable doing some of those things myself. I've had some pretty critical patients who were alert and talking one minute, and then lost consciousness and turned gray right in front of my eyes; at that point, you don't worry about technique, you get the necessary meds in and you do it FAST, or you can lose them.

    You see, there's school, there's tests, and then there's real life..........it takes time to learn how to differentiate between them and accord each their proper place. Good luck to you in your nursing education and career.
    I always enjoy and learn from reading your responses. So I'm a fairly new nurse (2.5 years) and I've always diluted Ativan and other narcotics as well as cardiac meds (and pushed over x amount of minutes). I've seen where IV pushes take effect on the patient after a few minutes- maybe 5 to 10. Don't we dilute to also have control on the effects on the patient? Does the undiluted medication take a faster effect on the patient? I would think so. Since narcotics and Ativan are CNS depressants, I would think it cause aspiration after seconds of an undiluted iv push if the patient drank something a few minutes after? Has anyone seen this happen?
  9. Visit  CRNA1982 profile page
    3
    All of the things that you were taught to "worry about" in nursing school regarding IV push meds can be quite overwhelming. In my experience in the O.R; I can tell you that we PUSH meds whenever needed, in PRBC's, undiluted....whatever. I have never seen any adverse reactions.... Just saying. Good luck with school.
    surferbettycrocker, CCL RN, and ®Nurse like this.
  10. Visit  CRNA1982 profile page
    3
    Quote from GoNightingale
    I always enjoy and learn from reading your responses. So I'm a fairly new nurse (2.5 years) and I've always diluted Ativan and other narcotics as well as cardiac meds (and pushed over x amount of minutes). I've seen where IV pushes take effect on the patient after a few minutes- maybe 5 to 10. Don't we dilute to also have control on the effects on the patient? Does the undiluted medication take a faster effect on the patient? I would think so. Since narcotics and Ativan are CNS depressants, I would think it cause aspiration after seconds of an undiluted iv push if the patient drank something a few minutes after? Has anyone seen this happen?
    If you have concerns of your pt. being an aspiration precaution, then you should probably be questioning an Ativan IVP order..... 1 mg IVP of Ativan would most likely not make a full stomach pt. aspirate with a normal LOC. You must treat every patient individually and go with you "gut feeling".
    Esme12, sicushells, and GoNightingale like this.
  11. Visit  GoNightingale profile page
    0
    Quote from CRNA1982
    All of the things that you were taught to "worry about" in nursing school regarding IV push meds can be quite overwhelming. In my experience in the O.R; I can tell you that we PUSH meds whenever needed, in PRBC's, undiluted....whatever. I have never seen any adverse reactions.... Just saying. Good luck with school.
    Thanks CRNA1982 for your helpful comments. It's people like you and VivalaViejas that make me love this website! Best wishes!
  12. Visit  Biffbradford profile page
    12
    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) ... would I push Ativan undiluted into his central line to hopefully keep him from self extubating himself? ... you bet I would!
  13. Visit  MomRN0913 profile page
    0
    Quote from versed88
    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.

    Ditto. I never dilute it. I push it into a KVo line if I have one, but other wise, no dilution and the 18Guage needle helps with drawing it up.
  14. Visit  ®Nurse profile page
    0
    I've given ativan IVP undiluted many times. For my PICC lines, I'll draw 2mg up in a 12cc syringe (only because we don't seem to have any 10 cc syringes in stock in our ICU).

    Our Ativan drips come concentrated in 50 ml bags i.e. - undiluted. I've frequently maxed those out at 20 mg per hour......
  15. Visit  ICUPrincessNurse profile page
    0
    I usually dilute it with some Fentanyl if they're intubated/sedated. 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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