Ativan IVP given undiluted into central line.

[Septic Boy]

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?

[Biffbradford]

Oh no. You certainly wouldn't want to cause any discomfort in your patient who's thrashing about in the bed, trying to break the restraints, and bucking the vent. "Now now, Mrs Jones (yes, I typed Mrs), stop that before you hurt yourself."

Depending on the circumstances, of course, you want to GET IT IN. NOW.

[mpccrn, BSN, RN]

I usually dilute it with NSS

[EyeSeeYouRnOhio]

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.

Oh I HATE DT's!!! I am a ICU nurse not a detox center. Nothing works on alcoholics!

[armyicurn]

Oh I HATE DT's!!! I am a ICU nurse not a detox center. Nothing works on alcoholics!

Try a beer, that should work :D:D:D:D

[lna2rn]

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...

"The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. " http://www.globalrph.com/lorazepam_dilution.htm

I guess the site agrees that one should be comfortable with thier own clinical judgement before administering any drug. I personally dilute whenever possible but I certainly do not when the patient's safety is at risk and they have a central line. I always dilute for PIVs so as to not blow the line.

[montinurse, BSN]

Is it possible for someone to experience DT's for over 7 days? I'm an ICU nurse also, never imagined dealing with so many DT's and OD's!

[Maevish, ASN, RN]

I dilute it because it says to in the drug book and since that was my bible in nursing school it's just automatic.

[Teleflurry, DNP]

Because it's so viscous - I always mix it with saline to prevent it from sticking to the tubing and the pt not getting the correct dose. Until you get that one wild patient that makes you give it undiluted right into the closest port then flush liberally then it's lights out ..zzzzzzzzzzzzz

[Spoiled1, MSN, RN]

I have given it both ways; diluted and undiluted. I prefer to give it diluted in peripherals because its so thick and it burns when going in.

[brillohead, ADN, RN]

I just love this site.... I learn sooooo much from you folks that I'd never learn in lecture!

[funkywoman]

i usually draw up one ml of saline and push into the ativan vial just so I can draw it up easier, takes longer to draw it up undiluted then to just cut with a bit of saline. I see no reason to not push straight though because I have worked in one place where ativan came in carpujects and that also worked fine.

[Five&Two Will Do]

I think the only real issue is the size of the syringe being used on the central line. They claim that anything smaller than a 10ml syrine generates too much pressure in the line and you risk splitting the catheter. I have never heard of this actually happening and I know some nurses that will use a carpuject into a PICC. That being said, if I am going to give the entire vial, of whatever med, it is often just as easy for me to draw it up in a flush, mix it a couple times, and go push it.