Diluting IV narcotics = narcotics tampering?

ChristineN, BSN, RN · Jan 28, 2009

I'd ask to see proof. I work in peds and it's downright unsafe, IMO, to give Morphine, Dilaudid, or other narcs without dilluting them.

morte, LPN, LVN · Jan 28, 2009

i think someone is a bit looney, and i dont mean the OP.....if the doc wants it run in over so many minutes via a partial fill ....that is what he/she wants.....and i suppose "they" want you to shut off the iv and push it? sounds like you have hmm some one in management who likes their meds

hikernurse · Jan 28, 2009

We always dilute narcs in the NICU, too. We give such small amounts that the baby would get it all at once otherwise. Of course, we never get to use carpujets--as cool as they look .

If you put IV drugs in tubing with IV fluids that are already running, then it is diluted before the patient gets it; would they count that as tampering? :rolleyes:

UM Review RN, ASN, RN · Jan 28, 2009

I was told the other day that it is now illegal, yes illegal, to dilute IV narcotics because it means that we are now 'tampering' with narcotics. What do you think? We have now been told that ALL narcs must be given via Carpujects and can not be diluted.

Who told you that? You should ask to see the law in writing.

mcknis · Jan 29, 2009

This was posted per our staff developer today on our hospitals website. I am going to ask her to leave a copy of it in my mailbox and also to see examples of when diluting a med was considered a crime. She advised that when diluting we are tampering with the med. As soon as I saw it, i was like, "you've got to be kidding me woman. are you mad? how on earth is this realistic? also, are we going to start throwing out all of our drug reference books if we are going to rewrite them? it clearly states in our drug guides that MS and dilaudid both have to be diluted if given in a direct route!" ARGH...i talked with another nurse on our floor and she told me, "well P&P change so often so it will probably be back to the old ways again." If only we would look at pt safety for ALL things!!!

morte, LPN, LVN · Jan 29, 2009

i would be checking with risk mangement and the law firm that rep the hosp.....good luck

iluvivt, BSN, RN · Jan 30, 2009

What!!!!! I am assuming you are talking about IV administration. if you are diluting allows you to control the administration rate a bit better as well as dilutes medications that are very irritating to the veins. I find dilaudid to be very irritating,thougg keep in mind some IV medications no how much diluted are inherently irritating with or without dilution. If you give the med at a y-site it gets diluted anyway so the new rule makes no sense. The dilution does not cahnge the property of the drug,unless the diluent is incompatable so the patient gets the dose as prescribed so this makes no sense. Some of the rules are getting so silly and are really obstacles in providing good care sometimes.

Pediatric Critical Care Columnist · Jan 31, 2009

So how would you run a continuous narcotic infusion?

ChristaRN · Apr 30, 2009

Agreed. I also work in Peds and always dilute and administer over 10 minutes or so depending on the drug and the child

I'd ask to see proof. I work in peds and it's downright unsafe, IMO, to give Morphine, Dilaudid, or other narcs without dilluting them.

elthia · Apr 30, 2009

Ummm...I've had morphine IV push undiluted in a hand IV and it stung, not as bad as phenergan...but if I ever have morphine again, and I'm not having an acute MI, dilute it in 5-10 ml of NS thank you very much.

Undiluted meds also tend to cause chemical phlebitis and make IV sites go bad much faster.

Intubate89 · May 1, 2009

sounds like the hospital is covering their butt from a few addicted boneheads who give themselves the narcotic rather than the patient.