Dilute IV meds or not?

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I followed behind a nurse who said that she dilutes all her IV meds before giving them. I was told last year when precepting that you don't have to and it really doesn't do the patient harm if you don't. So I haven't been, until a couple of days ago...I have giving 5mg IV Lopressor and felt compelled to dilute it with 2ml of NS. So I was doing that....

But now I look back and wonder, how many of you guys dilute your IV meds? It's not really necessary....Most of the meds we push IV are in Central Lines and PICC's. What's your thought?

Be careful of this...We had a kid OD on morphine cause the nurse before didn't flush the med all the way through and when the new nurse came on and gave more morphine the kid got a double dose.....nursing standard is you give the meds closest to thepatient to advoid a overdose!

I would never give morphine via the high port - the only one I sometimes do is phenergan and that is in a running IV.

The only reason I sometimes give phenergan via the higher port is all the stuff I keep reading on here about how bad phenergan is - even diluted it has a high pH that burns supposedly. However, I have to repeat I have never had any negative effects from phenergan and I give it all the time.

Good point about the high port - we don't have many peds patients in the first place and I've never had one we give morphine too. But something to keep in mind.

steph

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Specializes in ER, PACU, OR.

I have pushed many different things, over and over. I almost never dilute, with the exception of ABX, Dopamine, Dobutamine, Dilantin, Levaphed, tPA, and nitro. Stuff that is meant to be on a drip or over 30 minutues or longer.

The more important thing is? What can it do to the person if it is pushed? The bottom line is if you push it slow enough, it shouldn't matter?

The only thing that I diluted that didn't need to be was compazine IV. basically, we has seen a lot of extrapyramidal effects (EPE) with compazine. Allegedly that comes from the rate of infusion. So I threw it up in 100cc bags for a few months, but doing that did not change the frequency of EPE.

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Specializes in CCU (Coronary Care); Clinical Research.
The nurse I followed said she was diluting with 5:2...meaning 5ml lopressor to 2ml NS. I did the same thing. I was concerned mainly because the lopressor was working so quickly, even tho I was pushing it in over 5 minutes. After slowly flushing the line...the patient's V-Tach with occasional PAC's went from 135 to 100 to 80 to mid 70's in a matter of minutes. It scared me at first and I wouldn't leave his room just glaring at the machine.

:rolleyes: The pt was like, "is everything okay?" I told him he was fine, I just wanted to watch his rhythm...and retook his irregular blood pressure.

The MD was telling me that Lopressor is quick and short acting. It is in and out of the system quick. It sure was, by the time the next dose was due (6 hours later), he was back in V-Tach!

I was so worried because this guy had a hx of A-fib and I was praying to *G* all night...saying, "please...not tonight. Not ever...no no no."

Thanks for everyone's responses....I love learning new things!

IV lopressor is a quick drug- it's onset is considered immediate...peaks in 20 minutes and the duration is 5-8 hours. PO lopressors onset is 15 minutes and the duration is 6-12 hours. We use a lopressor protocol frequently for our MI patients (as I am sure that many hosptials do). Our protocol calls for 5 mg IV lopressor to be given over 30 seconds. 2 minutes later we give another 5 mg dose over 30 seconds. We wait 5 minutes and if tolerated, give another 5 mg dose over 30 seconds. If in 15 minutes, all of this is tolerated- we start 50 mg PO Q6 hours- of course we monitor HR and BP pretty closely thoughout the whole procedure and have some stop parameters as well.

You can give it direct IV without diluation and per the drug book it can be "given rapidly" so you don't need to stand there for 5 minutes.

As for dilution, I don't usually dilute anything unless it specifically states that it has to be diluted (or if I am giving ativan/phenergan or something else that is fairly "thick" or caustic). I don't actually think that I have ever given phenergan IV...If I have a tko line, I do try to push meds through that...but i use the low port typically.

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phenergine and ativan. I always dilute them. If the situation allows I like to hang a tko n/s. That way you can give phenergine in the high port...I push a little, pull back a little, push a little...

Phenergine can be nasty on viens...ALWAYS dilute it. Ativan is oily and thick and if you are only giving a little it can be hard to push it slow.

If you don't dilute Phenergan you will be listening to a screaming patient WHILE you start the IV in a new location. Same with Diphenhydramine and a slew of others.

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Specializes in Transplant, homecare, hospice.
IV lopressor is a quick drug- it's onset is considered immediate...peaks in 20 minutes and the duration is 5-8 hours. PO lopressors onset is 15 minutes and the duration is 6-12 hours. We use a lopressor protocol frequently for our MI patients (as I am sure that many hosptials do). Our protocol calls for 5 mg IV lopressor to be given over 30 seconds. 2 minutes later we give another 5 mg dose over 30 seconds. We wait 5 minutes and if tolerated, give another 5 mg dose over 30 seconds. If in 15 minutes, all of this is tolerated- we start 50 mg PO Q6 hours- of course we monitor HR and BP pretty closely thoughout the whole procedure and have some stop parameters as well.

You can give it direct IV without diluation and per the drug book it can be "given rapidly" so you don't need to stand there for 5 minutes.

As for dilution, I don't usually dilute anything unless it specifically states that it has to be diluted (or if I am giving ativan/phenergan or something else that is fairly "thick" or caustic). I don't actually think that I have ever given phenergan IV...If I have a tko line, I do try to push meds through that...but i use the low port typically.

Oh, okay....Thanks. :p

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Specializes in Perinatal, Education.

Isn't the correct answer to look the drug up and follow the administration guidelines? My hospital uses micromedex on-line and I always check before giving new things. That is the standard for our facility and if I give the med a different way that could be a problem.

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Specializes in Transplant, homecare, hospice.
Isn't the correct answer to look the drug up and follow the administration guidelines? My hospital uses micromedex on-line and I always check before giving new things. That is the standard for our facility and if I give the med a different way that could be a problem.

Yes, yes, and yes. We use it too and you are correct.:rolleyes:

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Specializes in Telemetry, ICU, Resource Pool, Dialysis.
The nurse I followed said she was diluting with 5:2...meaning 5ml lopressor to 2ml NS. I did the same thing. I was concerned mainly because the lopressor was working so quickly, even tho I was pushing it in over 5 minutes. After slowly flushing the line...the patient's V-Tach with occasional PAC's went from 135 to 100 to 80 to mid 70's in a matter of minutes. It scared me at first and I wouldn't leave his room just glaring at the machine.

Diluting it isn't going to delay the onset of action. And, yeah, that's the beauty of lopressor - it works quick. But I wouldn't ever push lopressor quickly (less than 5 minutes per 5mg) because it will act differently on each patient. It takes less time to stand there for 5 minutes than it will to code someone who no longer has a BP! Just look stuff up before you give it and check the recommendations on diluting, and rate of administration. Some drugs will actually precipitate if you try to dilute it.

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Specializes in Perinatal, Education.
Yes, yes, and yes. We use it too and you are correct.:rolleyes:

I am a relatively new nurse (3 1/2 years) and I'm very careful. I can't tell you how many times I have followed a very experienced nurse who told me to give a med a certain way because that's how they have always done it. I look it up and find they are wrong. A good thing to keep in mind is just because it is how you have always done it doesn't make it the correct way.

If you have a bad outcome and are up on the stand, they will ask you why you gave the med that way. Did you look it up? Does your facility give you a resource? Did you use it? This is pretty basic stuff.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I am a relatively new nurse (3 1/2 years) and I'm very careful. I can't tell you how many times I have followed a very experienced nurse who told me to give a med a certain way because that's how they have always done it. I look it up and find they are wrong. A good thing to keep in mind is just because it is how you have always done it doesn't make it the correct way.

If you have a bad outcome and are up on the stand, they will ask you why you gave the med that way. Did you look it up? Does your facility give you a resource? Did you use it? This is pretty basic stuff.

very well-said.
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Specializes in Med-Surg Nursing.

I ALWAYS dilute IV Phenergan and ativan. As for other drugs, I do not routinely dilute them. Always follow your facilities protocol.

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Specializes in ER, NICU, NSY and some other stuff.

Janey That is one of the rules I live by and impart to anyone that I ever precept.

You look up those meds and become familiar with them. NEVER just give something like somebody told you that is how they do it or is the way they always did it. Each year when new med books come out things change, compatibilities/incompatibilities, dilutions delivery times etc.

I will guarantee you the person who told you how to do it wrong will not offer to go to prison or pay that wrongful death settlement for you because they gave you improper information. I NEVER give a new, unfamiliar med without getting out the med book and making sure that I am giving it properly.

As I stated in my original post I personally am in favor of diluting meds UNLESS it is contraindicated. I do this for patient comfort as many solutions are very irritating.

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