diluting IV push meds

[peaceful nurse, RN]

I have been out of nursing for a little bit and am currently teaching. I get confused about diluting medications that are IVP. Do all IVP meds need to be diluted? which ones do you all dilute? Say I have a 2 ml IVP drug do I just wast 2ml out of the NS prepared flush and draw up the med or is there math involved in diluting?

[xtxrn, ASN, RN]

peaceful nurse said:

I have been out of nursing for a little bit and am currently teaching. I get confused about diluting medications that are IVP. Do all IVP meds need to be diluted? which ones do you all dilute? Say I have a 2 ml IVP drug do I just wast 2ml out of the NS prepared flush and draw up the med or is there math involved in diluting?

For me, it all depended on the primary IV- if it was NS, I usually didn't dilute, but gave the med slowly. If there was no primary IV, I always diluted to 10cc (drew up 8cc of NS, then 2cc of med - or however it was packaged for the needed dose)...still did SASH (or no "h" if a SL). I prefer the increased control of delivery with a greater volume. I used 10 cc because it was an easy number to deal with. If for some reason I couldn't give the full dose (pt c/o feeling different, etc), I had a better idea of how much they got. JMHO. The med should come with a label that says if it needs to be diluted. ?

[LovingNurse, BSN, RN]

When I dilute, I always add the NS last. For example, If I am pulling up DRUG X, I will pull up correct dose in a syringe, then, while the needle is still attached - I will pull NS from the flush syringe into the syringe that has the med in it. This way, there is never any doubt that I have the right amt of med.

If adding to a prefilled syringe, and you accidently pull back too much - then what? I know some nurses do it that way. I'm just saying my preference.

[CharmedJ7]

I dilute narcotics because it's pretty hard/impossible to push 0.5ml slowly. I dilute benadryl because it's irritating to the vein. I dilute ativan sometimes for the same reason as narcotics, plus it's kind of thick. Mostly I dilute, usually in 10ml NS, if:

1) It needs to be pushed very slowly and it's a very small amount

2) It's irritating to the vein

3) It specifically requires it.

[maelstrom143]

I always dilute, unless med specifically says not to dilute. No specific mathematical requirement, just common sense. We have prefilled 10cc nss syringes, so I discard whatever the amount necessary to make space for cc of med (i.e. Lasix 40mg is 4ml so I discard 4ml nss). I like to dilute to make it easier and safer on the veins and the patient. Also, w/Lasix I always worry about ototoxic effects of pushing too fast.

[turnforthenurse, MSN, NP]

I usually dilute narcotics because I'm usually giving 0.4-0.5mL and it's just easier to push with more volume (NS). I dilute Ativan because it's thick (and it should be diluted anyway) and medications that are irritating to the veins, such as Zofran. I draw the medication up in a syringe and then take a separate NS flush (10cc) and squirt how an amount depending on how many mL's of medication I am giving (so 2mL's of Zofran, squirt out 2mL's of NS) and then inject the medication into the NS syringe. That way I know exactly how much I am drawing up instead of accidentally drawing up too much and not being able to tell because of the NS.

[turnforthenurse, MSN, NP]

Oh, and a diluent should be added to the I&O...

[poopprincess]

I dilte most everything, unless specifically stated otherwise. Nothing that I ever give says not to. We have 10 cc prefilled syringes so I squirt out the amount of med I am drawing up and draw the med to equal 10 cc. I basically do the exact same thing turnforthenurseRN does. :)

[mandaaRN]

Do you still flush with 5cc before and after

[ktliz]

I am a new nurse and I am constantly looking up meds before I give them. My hospital uses Micromedex online. Under the "administration" tab, it tells you how the med may be diluted and how quickly to push it.How I draw it up depends on the amount of med vs the amount of saline, and whether I am drawing up the whole vial or not. Sometimes I just waste a few ccs of my nss flush and then draw the med directly into there. Other times I will use a separate syringe to draw up my med, and then draw up some nss from the tip of the flush.

[Gray Fox]

I sure hope that some of you have seen the ISMP survey results from 2014 about diluting IVP meds. Very few IVP meds need to be diluted. Diluting meds, especially in saline syringes, adds significant risk points to the process without adding value. Even small volume narcotics can be managed without dilution. Think about it - if you are injecting into a saline lock with extension tubing or a running IV, you would use the SAS method - flush, give med, then flush. The undiluted med volume is likely still in the iv tubing no matter how fast or slow you give it, so the rate of the flush administration is more important than the rate of the med administration. I have seen some new ready to administer syringes on the market (not like carpujects) that do not need diluting. Maybe it is time to question an old habit.............

[VANurse2010]

I almost never dilute unless the med specifically requires it.