IV push meds & dilution practices

  1. I work with a RN (for 1-1/2 yrs) who has recently told me and a student nurse she is precepting that "you always dilute all IV pushes with NS." I never dilute an IVP med unless I have checked to make sure it is compatible with the NS. The student nurse asked me about this later and I told her why I didn't do it. She asked me what drugs did I know of that are commonly given IVP (on an oncology unit and other than chemo drugs) that are incompatible with NS. I couldn't think of any right off to tell her so I am doing some research on it. I am a fairly new RN myself. I am hoping to give her some info on this next week when she returns to our unit. Can anyone give me some common meds that ARE NOT compatible with NS? Thanks so much!
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  2. 8 Comments

  3. by   lgoins
    Tory,

    I'm sure you've researched your question by now. I hope I can add to your research. There are exceptions to almost every rule. I don't think we should "always" do anything with every single meds, except the 5 rights. Normal saline is pretty safe. You've probably had a hard time finding medications that can't be run with it. On my oncology unit we give quite a lot of biological response modifiers, such as interleukin and interferon. Oddly enough, interleukin is not compatible with Normal Saline - EVER!

    There was a time when IV meds were diluted with NS. Research has shown that many meds can be given through a side port of IV fluids that are already running. The fluids are used to dilute the medication to decrease the risk of vein irritation or phlebitis. Narcotics are a big culprit. Very few medications must be diluted anymore. One that still should be diluted is lorazepam. Medications that are especially viscous (like lorazepam) tend to stick to the inside of the syringe as well as cause vein irritation.

    Being an experienced nurse doesn't make someone right automatically. I'm glad you researched this & did your own independent thinking. Healthcare definitely needs nurses that can & will think for themselves. Good for you!
  4. by   gwenith
    Erythromycin is the biggie - can't give it anyway the darn stuff turns to cement!!!! Diazepam is incompatable but I have seen people trying it. We have the Australian Injectable HandbooK at work and it is our bible lists most drugs how to give them - what precautions to take - what is compatable with what.
  5. by   wiegel34
    Oxaliplatin a fairly new drug give for colon cancer is incompatable
    with normal saline, it can only be mixedwith and given with
    D5W. It precipitates out in anything else.
  6. by   I_Love_Donuts
    flucanozole is not compatible with NS...as per our canadian protocoles....
  7. by   I_Love_Donuts
    flucanozole is not compatible with NS...as per our canadian protocoles....
  8. by   renerian
    WE diluted ativan for IVS that were not central lines.

    renerian
  9. by   pwp1289
    our pharmacy supplies all iv meds already prepared by the company or by pharmacy--the only drug we mix is erythromycin and that comes up in a bag with drug,dilute liquid and piggy back bag--even large volumes come ready-mixed with kcl-even small bolus bags are premixed
  10. by   kids
    I used to work with a nurse who said anything could be diluted in NS to equal 5cc and be given over 5 minutes...sounds good in theory.
    I never assumed, I checked the book before giving any push...to many drugs to remember the details and to many common ones to mix up in my head.

    Every med is premixed by the pharmasist at our local cancer center.

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