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Discussion

Diluting IM Haloperidol

I had to administer 0.25mg of Haloperidol (Seranace) from a 5mg in 1ml ampoule, for an agitated 82yr old. Firstly we queried the dose as it was smaller than I'd ever given. As it was only 0.05ml we used an insulin syringe but even that didn't seem quite accurate enough and the needle was fine and short for IM injection although patient was very thin. I'm now thinking I should have diluted the ampoule and given a larger volume but I can't find any info on safety of this. Could I use normal saline?

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    I'm not sure, maybe in NS to make 1mL? Did that low dose even do anything? I've never given less than 2mgs.

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    I went off shift soon after. I did check with the geriatrics dr who ordered it because I've never given such a low dose either! It was hrly as well. This was the first dose.

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    The insulin syringe will be SQ, so absorption will be different & using a 3cc syringe would be dangerous. Giving this hourly is creating an hourly opportunity for error. Is there any alternative to giving IM?

    Several possible solutions:

    use a needless TB syringe with a IM needle attached.

    switch to a lower potency (larger volume) medication that can more easily drawn up accuracy.

    SL or "Meltable" antipsychotic.

    Consider low dose anxiolytic instead of antipsychotic for agitation.

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    Call the pharmacy and ask

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    Agreed on consulting the Pharmacy to advise - IMO, the same applies

    to any unusual Rx dosage/administration regime, & especially psycho-actives.

    I'd advise carefully noting that you conferred with the Pharmacy re proper protocol,

    with an advisement to be retained - to handover to the following nursing duty team,

    & for the prescriber.

    Haloperidol has been noted to be prone to cause adverse reactions,

    - even in very small doses.

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    Don't think you'd want to use an insulin syringe as they are in units. A tuberculin syringe will be in mls.

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    I have to correct myself…the U100 insulin syringe is a 1ml syringe. Looked at it today on the floor!

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