diluting IV push meds

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    I have been out of nursing for a little bit and am currently teaching. I get confused about diluting medications that are IVP. Do all IVP meds need to be diluted? which ones do you all dilute? Say I have a 2 ml IVP drug do I just wast 2ml out of the NS prepared flush and draw up the med or is there math involved in diluting?
  2. 9 Comments so far...

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    Quote from peaceful nurse
    I have been out of nursing for a little bit and am currently teaching. I get confused about diluting medications that are IVP. Do all IVP meds need to be diluted? which ones do you all dilute? Say I have a 2 ml IVP drug do I just wast 2ml out of the NS prepared flush and draw up the med or is there math involved in diluting?
    For me, it all depended on the primary IV- if it was NS, I usually didn't dilute, but gave the med slowly. If there was no primary IV, I always diluted to 10cc (drew up 8cc of NS, then 2cc of med - or however it was packaged for the needed dose)...still did SASH (or no "h" if a SL). I prefer the increased control of delivery with a greater volume. I used 10 cc because it was an easy number to deal with. If for some reason I couldn't give the full dose (pt c/o feeling different, etc), I had a better idea of how much they got. JMHO. The med should come with a label that says if it needs to be diluted.
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    When I dilute, I always add the NS last. For example, If I am pulling up DRUG X, I will pull up correct dose in a syringe, then, while the needle is still attached - I will pull NS from the flush syringe into the syringe that has the med in it. This way, there is never any doubt that I have the right amt of med.

    If adding to a prefilled syringe, and you accidently pull back too much - then what? I know some nurses do it that way. I'm just saying my preference.
    tampasheri and IBRN2 like this.
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    I dilute narcotics because it's pretty hard/impossible to push 0.5ml slowly. I dilute benadryl because it's irritating to the vein. I dilute ativan sometimes for the same reason as narcotics, plus it's kind of thick. Mostly I dilute, usually in 10ml NS, if:
    1) It needs to be pushed very slowly and it's a very small amount
    2) It's irritating to the vein
    3) It specifically requires it.
    tampasheri and turnforthenurseRN like this.
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    I always dilute, unless med specifically says not to dilute. No specific mathematical requirement, just common sense. We have prefilled 10cc nss syringes, so I discard whatever the amount necessary to make space for cc of med (i.e. Lasix 40mg is 4ml so I discard 4ml nss). I like to dilute to make it easier and safer on the veins and the patient. Also, w/Lasix I always worry about ototoxic effects of pushing too fast.
    Vespertinas and poopprincess like this.
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    I usually dilute narcotics because I'm usually giving 0.4-0.5mL and it's just easier to push with more volume (NS). I dilute Ativan because it's thick (and it should be diluted anyway) and medications that are irritating to the veins, such as Zofran. I draw the medication up in a syringe and then take a separate NS flush (10cc) and squirt how an amount depending on how many mL's of medication I am giving (so 2mL's of Zofran, squirt out 2mL's of NS) and then inject the medication into the NS syringe. That way I know exactly how much I am drawing up instead of accidentally drawing up too much and not being able to tell because of the NS.
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    Oh, and a diluent should be added to the I&O...
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    I dilte most everything, unless specifically stated otherwise. Nothing that I ever give says not to. We have 10 cc prefilled syringes so I squirt out the amount of med I am drawing up and draw the med to equal 10 cc. I basically do the exact same thing turnforthenurseRN does.
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    Do you still flush with 5cc before and after
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    I am a new nurse and I am constantly looking up meds before I give them. My hospital uses Micromedex online. Under the "administration" tab, it tells you how the med may be diluted and how quickly to push it.How I draw it up depends on the amount of med vs the amount of saline, and whether I am drawing up the whole vial or not. Sometimes I just waste a few ccs of my nss flush and then draw the med directly into there. Other times I will use a separate syringe to draw up my med, and then draw up some nss from the tip of the flush.


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