Dilute Lasix before giving IV?

Nurses General Nursing

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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?

Specializes in Intensive Care/AG-ACNP Student.
4 minutes ago, Horseshoe said:

Something might well be unnecessary or even not best practice-but that's a different thing than being "out of our scope of practice”

Exactly, there are times when we have to do what we have to do in whatever circumstances, I think the key is to put forth a good effort to do the best thing and then fall back to next best. One has to be more conscious of what they are doing when doing something out of ordinary.

2 Votes
19 minutes ago, JKL33 said:

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.

Well, those would be good rationales for diluting certain drugs. ? But what I was referring to was the carte blanche policy another poster spoke of that required diluting all meds in a 10cc NS flush syringe. Why? It's a good bet many of the drugs weren't meant to be diluted with NS. Also a good bet those syringes marked NS were never labeled to reflect what was actually IN the syringe. Remember the disaster at ? Syringes weren't labeled. Could that have been a factor? Even if it wasn't that's certainly a risk for error. As nurses I think focusing on processes that minimize errors is one of our most important roles.

3 Votes
17 minutes ago, JPnewACNP said:

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

Not at all meaning to bust your chops but the IV bag manufacturers do not recommend this because they cannot guarantee it won't leach into the IV fluid. Always better to write on a label and add to the bag. ?

9 Votes
2 minutes ago, Wuzzie said:

As nurses I think focusing on processes that minimize errors is one of our most important roles.

I completely agree.

My sole objection to this, really, is the attitude (not yours, but say from other entities that consider themselves stakeholders in this and related matters) that nurses can't be trusted to do x, y, z or that all our measly thoughts are mere tradition and completely lack any viable rationale. I am completely fine with the idea that some things I may have diluted in the past don't need to be diluted and therefore I have been working on changing my mindset ever since a rather harrowing discussion with another poster here in which I scrambled to defend myself. ?

In that discussion as well as this one, my objection isn't to the idea that I might gain new information or that I might become compelled to change my practice, it's just that I hate (I really do actually hate and despise) the fact that so often when things are discussed with nurses they can't just be discussed for the actual matters at hand.

Example/Problem: Nurses are not properly re-labeling pre-filled saline syringes as they know they should.

Convoluted discussion : Pre-filled saline syringes are devices and should only be pushed into a vein this way and not that way. Because they are "devices" it is wrong (implication: scientifically wrong) to push them that way. It's so ludicrous.

I would never have gotten so ramped up about it if we just could have had the basic straightforward conversation of, "we will provide the syringes in a ready-to-be administered form" in order to make it unnecessary to re-label anything.

1 Votes
3 minutes ago, JKL33 said:

I would never have gotten so ramped up about it if we just could have had the basic straightforward conversation of, "we will provide the syringes in a ready-to-be administered form" in order to make it unnecessary to re-label anything.

I get where you're coming from but the thing is we already have those and they are being used differently from how they were originally intended. Pre-filled NS flush syringes are a perfect example.

2 Votes
On 2/5/2020 at 9:17 AM, JPnewACNP said:

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.

You are wrong. You have to have an order to dilute medication. Just like you can’t combine medications when putting them down feeding tubes. It’s called compounding medication which is outside of your scope of practice. I know everyone does it, but you are not supposed to.

How are you supposed to decide exactly how much to dilute the medication with? How are you coming up with that number? You are not a pharmacist.

When I dilute Pepcid, I have an order on how much. Same with any medication that needs reconstituting or diluted.

I would take a look at your hospital policy. Because it’s going to tell you the same thing I just did.

1 Votes
Specializes in Community Health, Med/Surg, ICU Stepdown.

My instructor in nursing school taught us to flush NG with 30ml, give first med, flush with 5ml, second med, flush, etc. I still do it this way due to an irrational fear that she will show up behind me! (She was very strict!) when the patient has 20 NG meds it takes SO long and you are so irritated on a busy day. The temptation is there to mix them all and give them all at once but I have seen tubes clog due to this, especially dubhoff tubes. And no one wants to reinsert an NG, patient or nurse!

1 Votes
Specializes in Medsurg.
On 2/3/2020 at 8:34 PM, LibraNurse27 said:

I wouldn’t dilute with 50ml since patient is likely already fluid overloaded. I definitely do the slow push though ?

Lol right.

1 Votes
20 hours ago, LovingLife123 said:

You are wrong. You have to have an order to dilute medication.

When I dilute Pepcid, I have an order on how much. Same with any medication that needs reconstituting or diluted.

Sorry, that's just a silly assertion. I dilute/reconstitute meds all the time, according to the directions on the label.

No doctor's order is needed to do that. A doctor would think I was crazy if I asked for an order to reconstitute when there are explicit instructions right on the vial!

8 Votes

I don’t dilute unless it’s 80mg or higher. I just push lasix cautiously to avoid hearing loss. I’ve pushed 20-80 mg but when I had a patient ordered for 120mg, that was diluted and given over 10-15 mins!

On 2/5/2020 at 12:30 PM, LovingLife123 said:

You are wrong. You have to have an order to dilute medication. Just like you can’t combine medications when putting them down feeding tubes. It’s called compounding medication which is outside of your scope of practice. ...

[...]

Do you crush tablets and dilute with water for gastric tube administration?

10 hours ago, chare said:

Do you crush tablets and dilute with water for gastric tube administration?

Yes. Because that’s what my policy tells me to do. To dilute with 15mL of sterile water, then flush with 15mL sterile water. If it’s potassium or miralax, it tells me exactly how much to dilute with as well.

TJC will tell you the same thing.

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