Dilute Lasix before giving IV?

Published

When I give Lasix, I mix it in a 50ml bag of NS, and hang it over 2 minutes. If the patient already has some NS running I just push it over 2 minutes. Good practice?

3 minutes ago, Patrick8403 said:

What are you JCAHO? I got your policy hanging! I do what I want!

Geez, just trying to figure out what your thought process is because sometimes doing things differently is a good thing. You asked for opinions. If you didn't want them you shouldn't have put it out there.

And you can't just "do" what you want if it's wrong.

6
Up Vote Up Vote ×

Okay, someone bored with school right now?

Why is the OP showing up as two different screen names? guest1139088 on posts but Patrick8403 when quoted by others.

5
Up Vote Up Vote ×
Specializes in Ortho, CMSRN.

I was taught as a young nurseling to dilute every medication in a 10 cc flush. It's the culture in our hospital, but we all seem to think that this is the norm for nurses everywhere. We ESPECIALLY dilute narcotics. We were busy coming up with a consistant way to dilute our patients dilaudid when this: https://nursing.ceconnection.com/ovidfiles/00152193-201610000-00012.pdf

came out. And, if we believe in evidence based practice, then we have to pay attention and maybe admit that we've been doing it all wrong. According to the research, you DON'T dilute anything with anything else unless valid medication references or the manufacturer require it. That includes dilaudid. Dilaudid should not be given diluted. Morphine can be diluted, but only up to a certain point. It's hard getting other nurses to feel that this is safe though. I thought I was going to kill someone by pushing dilaudid straight! I've only been doing it for about 7 months now, but it was scary at first, so I get it.

6
Up Vote Up Vote ×

Seems a bit counterintuitive to add a diuretic that can be pushed undiluted, into a 50ml bag? I would say its bad practice

6
Up Vote Up Vote ×
Specializes in Medical Hematology/Oncology/Stem Cell Transplant.
10 hours ago, ClaraRedheart said:

I was taught as a young nurseling to dilute every medication in a 10 cc flush. It's the culture in our hospital, but we all seem to think that this is the norm for nurses everywhere. We ESPECIALLY dilute narcotics. We were busy coming up with a consistant way to dilute our patients dilaudid when this: https://nursing.ceconnection.com/ovidfiles/00152193-201610000-00012.pdf

came out. And, if we believe in evidence based practice, then we have to pay attention and maybe admit that we've been doing it all wrong. According to the research, you DON'T dilute anything with anything else unless valid medication references or the manufacturer require it. That includes dilaudid. Dilaudid should not be given diluted. Morphine can be diluted, but only up to a certain point. It's hard getting other nurses to feel that this is safe though. I thought I was going to kill someone by pushing dilaudid straight! I've only been doing it for about 7 months now, but it was scary at first, so I get it.

100% this. I used to work at a hospital that also dilutes every med in a 10cx ns flush, unless it’s a med that needs to be given as is like Metop. I changed to a new hospital now and they absolutely don’t dilute anything, unless it requires dilution or will help alleviate side effects.

3
Up Vote Up Vote ×
11 minutes ago, OncologyCat said:

100% this. I used to work at a hospital that also dilutes every med in a 10cx ns flush, unless it’s a med that needs to be given as is like Metop. I changed to a new hospital now and they absolutely don’t dilute anything, unless it requires dilution or will help alleviate side effects.

I still wonder what the rationale for this is. In another life I diluted meds but only because the doses were so tiny (premies) I needed to dilute to obtain a reasonably measurable amount to give.

Also, and I'm sure I'm preaching to the choir, if dilution is needed not all meds are supposed to be diluted in NS. Some require sterile H2O.

7
Up Vote Up Vote ×

Additionally, I'm sure the OP doesn't care about all the unnecessary charges his patients are incurring from this practice, but they certainly might.

2
Up Vote Up Vote ×
Specializes in Medical Hematology/Oncology/Stem Cell Transplant.
1 minute ago, Wuzzie said:

I still wonder what the rationale for this is. In another life I diluted meds but only because the doses were so tiny (premies) I needed to dilute to obtain a reasonably measurable amount to give.

Also, and I'm sure I'm preaching to the choir, if dilution is needed not all meds are supposed to be diluted in NS. Some require sterile H2O.

Alteplase for central lines came to my mind when you mentioned that ☺️ But yes when I was a new nurse I was told to dilute tiny doses so i have enough volume to push the med in 1-2min. Did not know that dilaudid shouldn’t be diluted, although i used to have a pt telling me undiluted dilaudid gives her nausea.

4
Up Vote Up Vote ×
10 hours ago, ClaraRedheart said:

And, if we believe in evidence based practice, then we have to pay attention and maybe admit that we've been doing it all wrong.

I am more comfortable with the idea that there is another (possibly better in some regards) way to do things...than the idea that we have been doing it all wrong technically speaking.

Saying, for example, that something is associated with errors is worth taking note of--and worth changing practice expectations--is good/fine. But implying that the old way is otherwise objectively "wrong" (as far as the science/chemistry, etc is concerned) is another matter. I don't care what reasons are given, the fact is that it is ludicrous to think that something that can hang in a bag of saline cannot also be diluted with saline when it is ordered as an IV push. Now, that might waste money, it might increase risk of error (especially if someone isn't going to label things as they know they should???), but ??. The whole thing about about the saline pre-filled syringes being a "device" and not a med may be true but also has nothing to do with science. It's a technicality that someone found and gleefully used it to change nursing autonomy that they wanted changed for other reasons. It worked out in favor of the camps that say nurses can't be trusted to do anything but receive a med from the pharmacist and push it (OH, wait! Nurses are incapable and unqualified to prepare medications unless the hospital isn't staffed with pharmacy 24/7, in which case....yes of course RNs can prepare medications!! ??). I'm all for EBP including knowing when it is being used disingenuously and when it is being called EBP even though it isn't.

6
Up Vote Up Vote ×
24 minutes ago, Wuzzie said:

I still wonder what the rationale for this is.

I am working toward diluting fewer things. ?

My main rationales for diluting have been:

- Patients telling me things burn even though I am a clock-watcher type of pusher

- Patients developing nausea even though I'm a clock-watcher

- Pushing a small volume of something into a saline lock where, when I'm "done" pushing it according to the clock and according to the fact that my syringe is empty, a third of it is still left in the pig tail portion, which I then see people then slamming with their saline flush which they do not push at the IV push rate. ??‍♀️?

1
Up Vote Up Vote ×
Specializes in Intensive Care/AG-ACNP Student.
On 2/3/2020 at 8:07 PM, LovingLife123 said:

Why are you mixing it? To me, that’s practicing outside of your scope of practice. There is absolutely no indication to do this.

When we have any medication that requires diluting, we have an order to do it and how much to dilute and with what, whether It’s saline or sterile water.

I don’t get why people think they need to dilute every medication. You can’t just decide to mix things and how much to mix them with. You are not a pharmacist.

I’m sorry to be blunt but, Mixing drugs is well within the scope of practice for an RN. I can think of dozens of scenarios where mixing my own drugs will save a life rather than waiting an hour for pharmacy to do it even with a clinical pharmacist calling for it stat.

This is a pet peeve of mine because some will say “it’s against policy” or “it’s unsafe.” If you are prudent with double checking everything, have a colleague double check if you have any doubt, and label it (even writing on the bag with a sharpie) then it is absolutely safe. “Outside my scope of practice” would not be a satisfactory defense to a lawyer why your patient died.

2
Up Vote Up Vote ×
3 minutes ago, JPnewACNP said:

I’m sorry to be blunt but, Mixing drugs is well within the scope of practice for an RN.

Yeah, I remember pausing at that post but didn't reply to it. Something might well be unnecessary or even not best practice-but that's a different thing than being "out of our scope." One could incorrectly mix a drug, but that's a med error, not a scope of practice issue.

2
Up Vote Up Vote ×
+ Join the Discussion