Deciding how much solution to dilute a medication in

Student100 · Mar 26, 2014

Hi everyone,

I've got a few questions about IVs.

When giving an IV medication, sometimes the doctor's orders will give you a range of medication you can give (eg. 12.5-25mg q6h). How do you decide how much you give the client? Is it based on severity of symptoms, or something else?

The second part to this question is when the drug monograph also gives a range of how much solution to dilute the medication in (eg. Dilute dose in 50 or 100 mL NS over 20-30 minutes).

My question is, how do you decide how much to dilute the solution in, and for how long?

Thanks in advance for any help!

SoldierNurse22, BSN, RN · Mar 26, 2014

Typically, you would gauge the dose based on the symptoms. For instance, if a patient is nauseated again and didn't get relief from their initial 12.5mg of (let's just say) Phenergan on last shift, I'd try 25mg Phenergan and see how it goes.

Dilution is usually directly proportional to the dose strength. Again using Phenergan, a vesicant, you'd want to dilute it in more fluid before you gave a higher dose so as to decrease the risk of extravasation. So for instance, 12.5mg in 50mL and 25mg in 100mL.

Your drug guide should tell you how long to run each drug based on dose strength. Many of them have instructions like "administer at a rate of 0.8mg/kg/hour" or something of that nature. If you don't see anything listed outright, call the pharmacy.

MrChicagoRN, RN · Mar 26, 2014

A range is not valid without parameters, so any IV would need titration orders.

You would dilute it according to MD/APN or pharmacy orders/protocol. You would administer it over the time period indicated in the order. May be hard to be exact without an iv pump. It may go in the shorter period if the person has good veins and can tolerate the rate. Slower if there are bad veins, not tolerated well,or other health concerns.

Esme12, ASN, BSN, RN · Mar 26, 2014

duplicate threads merged

nurseprnRN, BSN, RN · Mar 26, 2014

Also, if you want to give 1mg at a time of something that comes in 10mg/cc, it's usually a good idea to dilute it in something compatible so the final concentration is 10mg/10cc, so you can give 1 cc = 1mg more easily. Unless you're dealing with a baby where the difference between 1cc and 10cc is critical, this sort of thing is generally up to the nurse's discretion.

Student100 · Mar 26, 2014

Thank you for the replies, everyone. It's been helpful!

HeartNursing3 · Mar 27, 2014

You SHOULD have parameters if it says give 12.5mg-25mg of a medication. It should say to give 12.5mg for pain 5-7 and 25mg for pain 8-10, for example. If not, ask for them. If you make the call yourself, you are prescribing, at least in my state.

MrChicagoRN, RN · Mar 27, 2014

You SHOULD have parameters if it says give 12.5mg-25mg of a medication. It should say to give 12.5mg for pain 5-7 and 25mg for pain 8-10, for example. If not, ask for them. If you make the call yourself, you are prescribing, at least in my state.

Thats the case everywhere for anyone taking medicare, due to fairly recent changes in CMS regs.

emtb2rn, BSN, RN, EMT-B · Mar 27, 2014

A range is not valid without parameters so any IV would need titration orders. .[/quote']
Unless it's initially a verbal order from an ER doc to "titrate to life". You will however eventually need a real order with parameters.
The above is NEVER the correct answer on a test. One of the few times you'll want to go with "never".

ArmaniX, MSN, APRN · Mar 27, 2014

Thats the case everywhere for anyone taking medicare, due to fairly recent changes in CMS regs.

Question, so are you saying such orders as "Morphine 2 - 4 mg q 4 hrs PRN pain" is not acceptable anymore? The orders must now say 2 mg for pain 5-6; 3 mg pain 7-8 and 4mg pain 9-10?

MrChicagoRN, RN · Mar 28, 2014

^ That is what are quality person told us. Can't be a dosage range without a qualifier.