Diluting IV narcotics = narcotics tampering?

[mcknis]

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. What is your policy?

[dsgrandmarn]

That has to be wrong! We dilute almost everything that's given IV in my hospice, What are people thinking?!

[Nurturer3]

I agree with everyone. Does not make any sense at all. I have never heard of that logic.

[hotshot12345]

i've never diluted iv morphine or dilaudid before and i don't think anyone one my floor does. we do flush with NS before and after though. never had anyone complained about it. think about it, if somebody pain is bad enought that they need IV narc, are they really going to conks out? these people are either in a lot of pain or have a tolerance.

[cherrybreeze, ADN, RN]

The only time I usually dilute IV narcs are when I give Dilaudid...reason being, we only used to stock 2mg/ml carpujects, and when the dose is 0.2 or 0.3 (and on the floor we can only give a MAX of 0.75mg at a time, which is less than half a ml), it is impossible to give this tiny amount over a couple of minutes. So to me, that's a huge safety issue......

[cjcsoon2bnp, MSN, RN, NP]

I was just wondering if anyone attaches the needle less syringe to the IV line and withdraws fluid from the line in order to dilute the IV narc? I was just curious, it seems like that way you would be diluting it with the fluid that is already going into the patient and your not actually doing it until your ready to give the drug.

!Chris

[nerdtonurse?, BSN, RN]

If they make this a "rule" then I'd set up a bag of NS, put it on KVO, and do a slow push over 2 minutes. It would mix with the NS, diluting it, but you'd still be giving "undiluted" narcotics. And if I "accidently" aspirated some NS into the tube, pushed some, aspirated some more, pushed some more, etc., until I finally emptied out the tube, then who's to say? Narcotics scare me, we've had to push Narcan several times on my floor because the happy little druggies bring their own meds, and take their home narcotics AND ours. One of my biggest fears is that I have a pt die from an overdose, and I'm before the BON trying to prove that the pt overdosed themselves.

[GucciRN22]

don't the drug books say to dilute some narcotics/opiates as well? i'm getting confused.... i've always done it this way.

[Johnston]

Agghh We were talking on the unit today about this topic and can't understand why this would be the case. Our staff developer told us that is was "illegal" to dilute the narcotics. We are baffiled by this. Many are irritating and although we are supposed to give all through a carpujet, dilaudid is sometimes still in a glass vial!!! I hope to find this law to be false.

[morte, LPN, LVN]

Agghh We were talking on the unit today about this topic and can't understand why this would be the case. Our staff developer told us that is was "illegal" to dilute the narcotics. We are baffiled by this. Many are irritating and although we are supposed to give all through a carpujet, dilaudid is sometimes still in a glass vial!!! I hope to find this law to be false.

i cant remember, and didnt take the time to look,lol; wouldnt the pharmacy be the place to ask about this?

what is the rationale being offered by these persons?

[suni, BSN, RN]

i cannot imagine that this is accurate infomation as the IV drug handbook and the manufacturer recommendation say to dilute the med.

[Hoozdo, ADN]

I always dilute every narcotic I give with about 6-8 cc of Ns. In fact, I dilute every IV push drug unless it is in a code or rapid response. I work adult ICU. If I have a KVO line, I don't dilute and just push it at the Y-site.

I am curious to know the rationale also. Must be in response to some drug tampering/theft going on.

[SWS RN, ASN, RN]

I think what was ment is-sometimes when Nurses divert narcotics, they withdraw some of the med (for personal use) then add normal saline or sterile water to make the vial look full.

It is not against the law to dilute narcotics for patient use--for example in PICU we would often dilute morphine and place it in a buretrol to run in over 15 min. (In adult ICU we usualy push the ms.) This is done all of the time as long as the entire dose is going to the patient and not someone else.