Jump to content

Diluting Ativan?

Posted

Specializes in Emergency Medicine. Has 7 years experience.

OK my ER peeps. So my new boyfriend is an ICU nurse and we somehow came on the subject of ativan and he told me that it HAS to be diluted. I was like "what?? I've never done that, or been told to do that, or seen any other nurse do that". but when I look it up it says to dilute it. I've been working for 6 years now, and kind of feel like a complete idiot for not knowing this before. I just want yalls input on this. Just out of curiosity really. 

More Like This

MaxAttack

Specializes in trauma/surgical & neuro critical care. Has 6 years experience.

They also say administer it over a couple of minutes but when has that ever happened. 😂

I dilute it every now and then.. depends on my mood I guess. I never could find the reason for it but I would love to hear if someone knows why.

Edited by MaxAttack
small case LOL gets changed to capital LOL and it looks ridiculous

kaylee.

Specializes in Stepdown . Telemetry. Has 8 years experience.

It’s thick like syrup, that is why I dilute it.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

Your new boyfriend is incorrect.

Every couple of years the Institute for Safe Medication Practices (ISMP) puts out a reminder that it's a common myth that IV push medications need to be diluted, and that doing so might do more harm than good.

ISMP recommends only diluting when the manufacturers FDA labelling recommends doing so and/or when evidence exists to support doing so, for lorazepam it's not recommended or even suggested.  ISMP points out that the myth is common enough that it's often included in various drug guides, but these are commercial products that are not peer-reviewed or evidence based.

There are certainly times where it's necessary, for instance if you need to draw up 0.5mg of lorazepam from a 2mg/ml vial and you only have 5ml syringes, but generally it's not beneficial and should be avoided.

https://www.ismp.org/resources/some-IV-medications-are-diluted-unnecessarily-patient-care-areas-creating-undue-risk

https://www.ismp.org/sites/default/files/attachments/2017-11/ISMP97-Guidelines-071415-3. FINAL.pdf

https://www.ismp.org/resources/part-I-survey-results-show-unsafe-practices-persist-IV-push-medications

 

MaxAttack

Specializes in trauma/surgical & neuro critical care. Has 6 years experience.

5 hours ago, MunoRN said:

ISMP recommends only diluting when the manufacturers FDA labelling recommends doing so

The FDA information provided by Baxter:

"Immediately prior to intravenous use, ATIVAN Injection must be diluted with an equal volume of compatible solution."

https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/018140s028lbl.pdf&ved=2ahUKEwjWtJ7EyIPtAhVthOAKHUmuAZoQFjALegQIFxAB&usg=AOvVaw0cQOQgFgBdceXBx6GMCdug

Edited by MaxAttack

On 11/13/2020 at 12:58 AM, Nicole5128 said:

I was like "what?? I've never done that, or been told to do that, or seen any other nurse do that".

Well that's just weird. It sounds like too many nurses heard that in a good number of situations things don't need to be diluted so they just went with that mantra instead of actually looking it up. It's right in the labeling info as already mentioned above.  Here's an active link.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/018140s028lbl.pdf

 

I've always diluted it.  I don't know how IVP lorazepam is packaged in your hospital, but we draw ours up from single-use vials with a label instructing dilution.  When you dilute it, you can kind of see it swirling in the syringe - lorazepam is quite thick.

I am a compulsive label-reader, even in the supermarket.  I check and recheck the dilution requirements for everything I draw up, especially since we switched over to IVP for many of our antibiotics.  Even if it's something I've given before, at minimum, I look at the label to make sure nothing changed.

My advice is to check for the official policy or manufacturer's instructions rather than going by what other nurses do.

There's an old (1998) FDA approval for lorazepam labeling available online, it's very hard to read but it instructs on the need to dilute even the pre-filled syringes. The described procedure was to extrude the extra air from the pre-filled syringe and then withdraw the appropriate amount of diluent into the syringe. Probably neither here nor there, just saying I've never seen any manufacturer or FDA information suggesting that Ativan or the generic lorazepam was not to be diluted. I would be interested to know where anyone ever got the idea it wasn't intended to be diluted.

13 hours ago, turtlesRcool said:

I've always diluted it.  I don't know how IVP lorazepam is packaged in your hospital, but we draw ours up from single-use vials with a label instructing dilution.  When you dilute it, you can kind of see it swirling in the syringe - lorazepam is quite thick.

I am a compulsive label-reader, even in the supermarket.  I check and recheck the dilution requirements for everything I draw up, especially since we switched over to IVP for many of our antibiotics.  Even if it's something I've given before, at minimum, I look at the label to make sure nothing changed.

My advice is to check for the official policy or manufacturer's instructions rather than going by what other nurses do.

Over the years I have actually learned some things from reading labels and printed materials that I have then incorporated into my practice. Glad to see others read labels too.

0.9%NormalSarah, ADN, RN

Specializes in ICU. Has 2 years experience.

Oh dear, I have not been diluting. I typically rely on my MAR as it provides administration instructions from pharmacy, and if it doesn’t make sense to me I will look it up. This thread is causing me to change something about my nursing practice, I will be reading those labels more carefully! I wonder why our pharmacy instructions don’t include it though. I wonder if our pharmacy has decided there is no pertinent reason to dilute, or if they just figure we nurses know what we’re supposed to be doing. 🤣

Nicole5128, ADN, BSN, RN

Specializes in Emergency Medicine. Has 7 years experience.

On 11/17/2020 at 10:01 AM, 0.9%NormalSarah said:

Oh dear, I have not been diluting. I typically rely on my MAR as it provides administration instructions from pharmacy, and if it doesn’t make sense to me I will look it up. This thread is causing me to change something about my nursing practice, I will be reading those labels more carefully! I wonder why our pharmacy instructions don’t include it though. I wonder if our pharmacy has decided there is no pertinent reason to dilute, or if they just figure we nurses know what we’re supposed to be doing. 🤣

Same here! Our mar doesn't say anything, can't say I've looked at the vial but it comes in a carpujet which I always assumed was for direct injection. I actually asked my ED pharmacist the other day and she said there's no need to dilute it and I asked if it would prevent it from being caustic to the veins? She said no

but there is an FDA label saying it must be diluted and I told her this and she still said it doesn't have to?.... I'll take a closer look at the vial next time I pull it and I think I'm changing my nursing practice as well. Always learning something new in this profession. I do agree there are some meds that are unnecessarily diluted but I think it's usually not a bad thing. 

Edited by Nicole5128