Ativan IM?

emtb2rn, BSN, RN, EMT-B · Oct 28, 2009

The proper proceedure for diluting Ativan when giving IM or IV is to use a 1:1 ratio of ativan to sterile water. If you look it up in your published drug book it will tell you this. You SHOULD NOT give it undiluted, that's just poor nursing. It SHOULD NOT be mixed with things like haldol as one nurse mentioned, that is called a chemical restraint & it's against the law.

I also tend to dilute ativan with haldol in our er psych unit. Only done when necessary d/t pt actively psychotic and danger to self and me/co-workers. Not illegal if done with orders, which is always the case. Ativan is compatible in a syringe with haldol and per davis, should only be diluted when given ivp.

Davis also notes that ativan is best diluted with d5.

B52's definitely come in handy........

elkpark · Oct 28, 2009

The proper proceedure for diluting Ativan when giving IM or IV is to use a 1:1 ratio of ativan to sterile water. If you look it up in your published drug book it will tell you this. You SHOULD NOT give it undiluted, that's just poor nursing. It SHOULD NOT be mixed with things like haldol as one nurse mentioned, that is called a chemical restraint & it's against the law.

There is no reason why "Vitamin A" and Haldol together would necessarily be considered either "chemical restraint" or "against the law." It depends on the particular circumstances whether it is an appropriate (and legal) intervention.

I've been giving undiluted Ativan IM without problems for my entire career in psych. I've never seen anyone dilute it for IM injection.

Nursesince1977 · Oct 29, 2009

Actually the Davis drug book I have says sterile water is the best to use with ativan, however, Mosby's drug book suggest sterile water, D5W or 0.9NS. The point is, it needs to be diluted. Vitamin A???? really? Kind of sad that's the way you look at it. I'd be willing to bet most pharmacist would disagreed with the nondiluting or even haldol methods. I too have worked in hospital ER,ICU & as the house supervisor. I have been teaching nursing @ the college level for past six years & I assure you, we teach the importance of using reliable resources. I value my profession & still realize the need to continually educate ourselves in our profession for the safety of our patients.

Meriwhen, ASN, BSN, MSN, RN · Oct 29, 2009

I give it undiluted. But because I know an IM of it hurts, if possible I try to persuade the patient to go for the PO form instead.

Meriwhen, ASN, BSN, MSN, RN · Oct 29, 2009

BTW: my drug guide says if giving it IM, to do so undiluted and deep into a large muscle mass. Page 922, Prentice Hall Nurses' Drug Guide 2009 edition.

However, it should be diluted for IV use with equal amounts of D5W or NSS. Same page in the book.

elkpark · Oct 29, 2009

I give it undiluted. But because I know an IM of it hurts, if possible I try to persuade the patient to go for the PO form instead.

Of course, outside of an emergency situation, po is the preferred route.

Vitamin A???? really? Kind of sad that's the way you look at it. I'd be willing to bet most pharmacist would disagreed with the nondiluting or even haldol methods. I too have worked in hospital ER,ICU & as the house supervisor. I have been teaching nursing @ the college level for past six years & I assure you, we teach the importance of using reliable resources. I value my profession & still realize the need to continually educate ourselves in our profession for the safety of our patients.

I've been in psych for some 25 years, am Master's prepared, and have taught in both ADN and BSN programs. "Vitamin A" is a common, if snarky, nickname for Ativan in psych circles (we also often refer to Haldol as "Vitamin H," but I figured using both nicknames in the same sentence would be too confusing). So sorry that you don't approve.

You're right, though about the importance of using reliable resources. Here's what the manufacturer's (Baxter) literature says about giving Ativan IM:

Administration

When given intramuscularly, ATIVAN Injection, undiluted, should be injected deep in the muscle mass.

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=11882

(Emphasis mine)

Meriwhen, ASN, BSN, MSN, RN · Oct 29, 2009

Of course, outside of an emergency situation, po is the preferred route.

I've actually had one patient specifically request it IM. I told him that there was no need for it: he wasn't actively vomiting, and the Ativan wouldn't work any faster--it may have by a few minutes but that was no guarantee. Eventually I did convince him that PO would work just as well as if he got it by needle, and he wouldn't have a painful reminder of the medication the next morning

sharpeimom · Oct 29, 2009

when i worked as a psych nurse in the state mental hospital, i had to give ativan im when patients would become out of control and would refuse oral ativan. it isn't thick and viscous. rather, it's

thick and viscous! one time (thankfully before i injected my patient), i accidentally stabbed myself in the arm. it really does sting like crazy and despite the fact that i only injected a tiny tiny bit, i ended up napping in an unoccupied bed before driving myself home. the supervisor, a friend, covered for me. took quite a while to live that one down!

kathy

sharpeimom:paw::paw:

elkpark · Oct 29, 2009

I've actually had one patient specifically request it IM. I told him that there was no need for it: he wasn't actively vomiting, and the Ativan wouldn't work any faster--it may have by a few minutes but that was no guarantee. Eventually I did convince him that PO would work just as well as if he got it by needle, and he wouldn't have a painful reminder of the medication the next morning

Where I work, we get a number of people who want it IM because they apparently get a "buzz" from IM Ativan that they don't get from po (or believe that they do). I've had people spend a hour or more trying to convince me to call the physician and get an order for IM Ativan instead of the po they already have ordered. I simply refuse to do it, since there's no good clinical reason to do so and the IM route is more invasive and risky. Some of the other nurses "crumble under the pressure," though, and do it -- which just encourages the clients, of course ...

Meriwhen, ASN, BSN, MSN, RN · Oct 29, 2009

when i worked as a psych nurse in the state mental hospital, i had to give ativan im when patients would become out of control and would refuse oral ativan. it isn't thick and viscous. rather, it's
thick and viscous! one time (thankfully before i injected my patient), i accidentally stabbed myself in the arm. it really does sting like crazy and despite the fact that i only injected a tiny tiny bit, i ended up napping in an unoccupied bed before driving myself home. the supervisor, a friend, covered for me. took quite a while to live that one down!
kathy
sharpeimom:paw::paw:

i also accidentally stabbed my hand (and like you, thankfully it was a sterile needle) with an ativan/haldol mix. no burning or nappy feeling though...i guess i'm impervious to it in small doses :cool:

sharpeimom · Oct 29, 2009

i also accidentally stabbed my hand (and like you, thankfully it was a sterile needle) with an ativan/haldol mix. no burning or nappy feeling though...i guess i'm impervious to it in small doses

heck, two xstrength tylenol make me really sleepy...

my husband, on the other hand, can take anything and not get drowsy.

kathy

sharpeimom:paw::paw:

Whispera, MSN, RN · Oct 29, 2009

All my years in psych, we've given Ativan IM undiluted, and have mixed it with Haldol if necessary. I won't even begin to describe how sometimes I have had to be on the floor or otherwise in an uncomfy situation, injecting it wherever I can get big muscle access... (bracing self for impact...)