Diluting IV medication

rac1, ASN, BSN, RN · Sep 2, 2022

Certain IV push meds need to be diluted. It's easy to look up - do you have a Davis's Drug Guide? You can look up certain ones you use often on your unit and write a little cheat sheet for yourself (or use a "notes" in your phone for all your reminders). You'll have them memorized after a month. I literally brought my guide with me to work when I first started and just looked it all up. Meds that need to be diluted are usually considered "high risk" in some way - because of patient response, or risk of extravasation, or viscosity, or just the difficulty in the size of the dose being drawn up.

For example, I still always dilute morphine and push slow. It makes people sick, young and old, and especially opiate-naïve. I just like to. (Davis) states to dilute with at least 5mL sterile water or NaCl, and administer over 5 minutes (for 2.5-15mg doses). However, there is a whole push about product shortages and how it's not recommended to dilute morphine (and all opiates) "anymore." Things do change, and I am happy to do it, but I also find it safer to dilute and push slow than to draw up and push slow....it can make some people feel really awful when it isn't diluted. If the person is being administered continuous fluids you can also just draw it up straight and push it slow at the top of their line (depending on the rate of fluids), etc. A sickle-cell patient might not need it diluted or pushed super slow.... so it just depends on your experience and patient population. And also - I think nursing is an art AND a science. I like to think that when it does not change the medication properties, that I can have some leeway in how it is administered (over 2 minutes or 6..).

pantoprazole/Protonix is reconstituted with 10mLs NaCl - and pushed over 2 minutes.

ondansetron/Zofran is preferred to be pushed over 2-5 minutes (30 seconds min) but does not have to be diluted. However, I dilute it in a 10mL flush because I think it's easier to push 10mL slowly than 2mL...just a preference thing on my part.

promethazine, pantoprazole, ephedrine, phenylephrine, phenytoin and lorazepam needs to be diluted.

Just look through your drug guides, then talk to your preceptor and see what they say in comparison. And depending on your eMAR - it will give you specific instructions (some do a great job at this, and others leave a lot to be desired.) GL!

londonflo · Sep 2, 2022

Davis Drug Guide is the best. Unless you are working at a facility that is constantly implementing new drugs, you can save $ by buying a used one on eBay or Amazon, but no older than 2-3 years. That books is the easiest to use IMO.