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B52 cocktail

Posted

I understand that Benadryl, Ativan, and Haldol are not compatible when given in the same syringe IV push. However, is it safe to give when they are mixed in the same syringe and given IM? Thanks

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

Why do you think the three mixed in the same syringe for IV push are incompatible? Once you determine that then think about how they would be compatible mixing them in a syringe and delivering the medications another method.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

I give them in the same syringe all the time. Micromedex says they're compatible except for Benadryl and Haldol which is inconclusive. I've never had an issue, though.

Christy1019, ASN, RN

Specializes in Emergency/Trauma/Critical Care Nursing. Has 11 years experience.

I believe haldol and ativan are compatible, at least for IM injections, not sure about IV, but a lot of facilities stay away from haldol ivp unless pt is on a monitor anyways. I always do my benadryl separate, however its been so long that I've been doing it I don't remember if its because pharmacy said to, or if I was trained that way or what.

hope3456, ASN, RN

Specializes in LTC, Psych, M/S.

I work with a nurse who suggested this for a client we have - IM Ativan 6mg does not even phase his behaviors. She asked the physician but he will not prescribe it. Always wondered why.

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

Haldol and Ativan are compatible.

Ativan and Benadryl are compatible.

Haldol and Benadryl are not compatible.

So you are not able to give the B52 (or its variations) in one syringe: you will need at least two.

Benadryl really can't be mixed with much. Many of the nurses I've worked with make it a practice to give it separately even if it is compatible with another med.

How about straight Geodon or Zyprexa? Quite effective.

hiphopRN

Specializes in Psychiatric Nursing. Has 3+ years experience.

How about straight Geodon or Zyprexa? Quite effective.

I do think Geodon is pretty effective, we usually do Geodon and Ativan though. We hate when the docs order Zyprexa IM most of the time because for the majority of our patients it doesn't ever phase them. I also tend to like the B52 better for emergencies because it can be torture waiting for the Geodon or Zyprexa to dilute.

Also like others stated, we usually mix the Haldol and Ativan and then give the Benadryl separate.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

I believe that the most you can give IM is 3cc. So he gets 2 injections.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

I agree about the Zyprexa IM. It totally wears off in a couple of hours. Not effective for psychiatric emergencies with extreme violent agitation.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

Geodon is very effective for agitation secondary to the DTs.

Many years ago we gave a ten four over and out. 10 of haldol, 4 of ativan and 50 of benadryl.. This was only for the worst psychotic violent and truly dangerous patients in the ER.

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 19 years experience.

I wish we could do a B52 cocktail, but our physicians will not do it. It is either haldol or ativan and not both. I have seen some give geodon with good results. I wish they would think about using that more.

Christy1019, ASN, RN

Specializes in Emergency/Trauma/Critical Care Nursing. Has 11 years experience.

Geodon is very effective for agitation secondary to the DTs.

Many years ago we gave a ten four over and out. 10 of haldol, 4 of ativan and 50 of benadryl.. This was only for the worst psychotic violent and truly dangerous patients in the ER.

Wow I love that name and holy cow that's a lot of meds!

hiphopRN

Specializes in Psychiatric Nursing. Has 3+ years experience.

Geodon is very effective for agitation secondary to the DTs.

Many years ago we gave a ten four over and out. 10 of haldol, 4 of ativan and 50 of benadryl.. This was only for the worst psychotic violent and truly dangerous patients in the ER.

We've done 10-2-50 before but not 10-4-50. That sounds wonderful.

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

We've done 10-2-50 before but not 10-4-50. That sounds wonderful.

10/4/50 does work miracles on even the most psychotic patients.