Diluting all IV push medication??

Nurses General Nursing

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I had a nursing instructor tell a nursing student that "you must dilute all IV push medication with at least 10cc NS." I know that there are medication that must be diluted, but not all? I have not been able to find this standard in AL's nursing standards, just wanted to see if anyone knew of this being a nursing standard in your state and if so, where I could find information on the rationale. I think it could be a great implementation at my hospital, but first must find the evidence to back the idea. Thanks

Look up each med in your drug book. There are some that have recommendations to dilute and some that are not diluted. Giving a med correctly also depends on what diluent is used and how slowly it needs to be given.

THis is exactlly my thought process. Do what the drug guide says. If you don't "have" to dilute, but it is ok to do so, then probabl go ahead and do so. Keeps the veins happy.

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There are several abx we give IVP...we give most but vanc IVP.

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Specializes in ICU/CCU/SICU.

I always look this up in a drug book as well but off the top of my head and the drugs used often on my unit is that I always dilute Ativan and Morphine. We do not dilute Lasix or Digoxin or Protonix but we push very slow sometimes if need be on a Excelcier Pump ( a small little pump that can deliver 10 cc synringes) but like I said I ALWAYS check with the drug book or call pharmacy.

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Specializes in Telemetry, Oncology, Progressive Care.
In our hospital we push 1 gram/10ml Rocephin ivp...used very often in our ER. Only push antibiotic I am aware of, although our ER pharmacist insists others can be pushed...we just don't do it.

Maisy;)

Our hospital discontinued the use of Rocephin due to possible kidney damage and is using Claforan in place of Rocephin.

Not all IV meds should be diluted. Off the top of my head I can think of 3. An amp of dextrose, atropine, and adenosine. Sounds like your teacher needs to check her facts. In fact the faster you push adenosine the better and it must always go into a site at the AC or superior to the AC.

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I would think that not diluting ACLS meds is a given......since they typically come pre-packaged ready for assembly and push.

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Specializes in MIDWIFERY.
I am so glad to see this thread! I worried about IVP meds until a seasoned med/surg nurse told me to always dilute with up to 10 ccs and still push slowly, all in order to preserve the vein.

I recently had a patient with AIDS whose phlebitis was so bad that even saline was painful for him. Even premedicating with pain meds didn't help him.

All foreign substances are potentially vessel damaging. Why take the chance?

On a somewhat somber note and OT, an RN friend of mine had her contract terminated with an ER because she diluted phenergan for IVP! Talk about trumped up.....

Remember also that the IV site need to change at least every 72 hours.

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Specializes in MIDWIFERY.

Some antibiotics are very irritative to the veins ;augmentin ,cloxacillin etc .hence it is always wise to flush the iv site prior infusion ,dilute in 20mls ,then flush again.

Gentamicin if given in the same line with these antibiotics may crystalise as well ,and always read the manufacturers guide before given any medications you are not familiar with.

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I would like some clarification on giving IV medication through a port with a peripheral line infusing LR. A drug such as Zofran 4mg, given undiluted through a port with the IV running...the medbook states it can be given undiluted but given slowly ( I think it stated over 2 to 5 minutes). Do you give the med at the further port for greater dilution factor or give close to the hub and still flush before and after med? I don't see anyone pinching off the tube above the port prior to an IV push drug or stopping the pump if the solution is compatible....any feedback on this? What experience does anyone have with Reglan and a peripheral line? :nurse: Returning Nurse to the floor....

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Specializes in Emergency.
I would like some clarification on giving IV medication through a port with a peripheral line infusing LR. A drug such as Zofran 4mg, given undiluted through a port with the IV running...the medbook states it can be given undiluted but given slowly ( I think it stated over 2 to 5 minutes).

Do you give the med at the further port for greater dilution factor or give close to the hub and still flush before and after med?

I give zofran at either port. It isn't irritating, so it doesn't need to be diluted (but, you can dilute it if you want). If IVF are running, I let them continue to run while I push zofran. Now, if we're talking about different meds (other than zofran): If the medication is irritating or is strong (such as dilaudid), I dilute it and push it at the port that is the furthest away from the patient. If I'm running IVF to gravity, I will sometimes lock my syringe (with the medication drawn into it) to the port that is furthest away from the patient; then, I pull back on the plunger to draw the IVF into the syringe, therefore diluting the medication. Yes, flush before and after ALL your IVP meds.

I don't see anyone pinching off the tube above the port prior to an IV push drug or stopping the pump if the solution is compatible....any feedback on this?

I only pinch the tubing if it doesn't have an anti-reflux valve (some IV tubing will not allow you to back-flush). If someone is on IVF via pump, you can keep on pushing it while the pump is running (but only if the solutions are compatible).

What experience does anyone have with Reglan and a peripheral line? :nurse: Returning Nurse to the floor....

Reglan can cause people to freak out REALLY bad. I dilute it, push it very VERY slow (longer than 2 minutes; more like 5). If someone does have a reaction to it (very anxious, "I'm going to jump out of my skin", ripping out their IV), then we give benadryl 50mg IVP. I've noticed its usually women in their 20's-30's who have problems with reglan. Oh yeah, don't give reglan if the patient has a bowel obstruction (it increases GI motility, which is bad if someone is obstructed).

(this info may not be necessarily true for every IVP drug; some meds need to be given in a certain way, some are not compatible with certain IVFs; always look up a med before you give it if you are unfamiliar with how to administer it)

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Specializes in Cardiac Telemetry, ED.

We were taught, as a general rule, to dilute IVP meds in 10mL NS. We were also taught to use 10mL syringes for all IVPs. We were also taught to look up every med in our drug books prior to giving them, and to use the pharmacist as a resource.

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Specializes in NICU.

Reglan can cause people to freak out REALLY bad. I dilute it, push it very VERY slow (longer than 2 minutes; more like 5). If someone does have a reaction to it (very anxious, "I'm going to jump out of my skin", ripping out their IV), then we give benadryl 50mg IVP. I've noticed its usually women in their 20's-30's who have problems with reglan. Oh yeah, don't give reglan if the patient has a bowel obstruction (it increases GI motility, which is bad if someone is obstructed).

We dilute Reglan in a 10cc syringe, and run it as an IVPB over 20 minutes.

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Thank you all for your great information on diluting drugs for IV infusions. I am looking up all drugs that are routinely used on my floor for compatible solutions and if they need dilution. The information on the anti-reflux valve was great, the info on Reglan also is important. I will take the cautionary side if a drug seems to be possibly irritating, it would be prudent to dilute and give slowly.

I am thinking that Reglan may be helpful to dilute, 10mg is in 2ml and CAN be given undiluted if not exceeded 10mg per my drug book....but it could not hurt to dilute with 8ml of NS and deliver slowly....I am concerned about the risk of extrapyramidal symptoms( is that the jumping out of your skin feeling??) that requires benadryl as stated in the IV drug manual. Do many of you routinely dilute Reglan for a 10mg dose? We have the premade 10cc NS syringes...it seems to me to first draw up the correct amount of the drug and add that to the premixed NS syringe after discarding 2ml NS. I will look up Benadryl....states may be given undiluted but in 25mg increments over one minute Any comments? Also, on the pre and post medciation flushes, my research indicates 2 or 3cc flushes used for IV push at the distal or proximal port? I am such a detail person!!

Marty

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