Diluting IV push

[RN2B07]

I have a question..I am a new grad working with a preceptor and when I watched her draw up morphine IV 2mg she didnt dilute it, even tho the med book says to. The pt. had IV fluids running, I dont know if that makes a difference. Is she right, or should it be diluted? If it should be diluted which do you draw up first?? If a med is to be diluted, is that determined by the med book or would the hospital have a policy to go by?? Thanks:o

[WVUturtle514]

Was the order for 2mg Morphine? If so, there is no need to dilute the medication if the patient already had IV fluids running, since the fluid itself will dilute the medication sufficiently not to cause any discomfort to the patient. Was the nurse giving the medication through a central line or a peripheral IV? When I worked in the ER, I always diluted almost ALL of my IV push medications if I was giving it through a peripheral IV, simply because it is less irritating to the patient's vein. However, when I worked in the ICU, I hardly ever diluted Morphine if I was giving it through a central line. But like I said, if the dose was appropriate and the patient had fluids running, then I see no need for the medication to be diluted. Hope this helps!! Good luck to you!!!

[RN2B07]

The pt. had a peripheral line and IVF running. The morphine was supplied as 4mg/ml...pt. was getting 2mg. So would you still dilute or no?? Thanks

[Martibear]

I always dilute! IVF running or not. I guess I'm just anal. I would also draw the appropriate dose of the Morphine up in a 10 cc syringe then draw up the rest with NSS.

[sweetcheekers]

At my facility we give morphine IV push through a saline lock simply flushing before and after administration. We give it very slowly and I have had no complaints. I did have a Pt with a running IV though that said it burned so we gave it in a port that was higher rather than the one nearest her IV site. That worked well, too. The drug book I refer to does not state that it must be diluted. You do need to be cautious with rate of administration, though, so you do not cause respiratory depression. I might add that respiratory depression can still happen even if the drug is given slowly if the dose is too high or the Pts body is not ridding itself of the drug at a normal rate. You simply can cause respiratory problems in a Pt that would be capable of tolerating the drug otherwise by giving it too rapidly.

[WVUturtle514]

The pt. had a peripheral line and IVF running. The morphine was supplied as 4mg/ml...pt. was getting 2mg. So would you still dilute or no?? Thanks

Even though it was through a peripheral IV, I probably would not have diluted it for the simple fact that the patient had IVF going. If the patient did not have fluids running, then yes, I would have diluted it in 10cc NS and flushed well afterwards.

[AngelsRN]

I always dilute Morphine -- I dont use a flush if they have IV fluids running but the morphine itself is always diluted.

[TazziRN, RN]

I dilute by pushing it higher up the line, rather than pushing it at the hub. Even if it's through a lock I don't dilute morphine.\

That didn't make much sense, did it? Okay.....I never dilute morphine but if there is IVF running I give it higher up the line than at the hub.

[SharonH, RN]

I would not have diluted that. With such a small amount and since there were IVFs running, there was no need in this instance.

You should check your hospital's policy on such a thing and in the absence of a policy, check the drug book.

[pugmum]

It wouldn't hurt to ask your preceptor the rationale for not diluting the med, even though it is recommended in your drug book (not in a challenging way). Perhaps there are hospital guidelines regarding the dilution of meds that you have not yet had an opportunity to learn about.

I would check to see if your hospital has a pharmacy medication administration manual. If the question came up with morphine, it may come up again with other drugs, and its much better to be prepared and know where your reference material is.

[cheeca]

First may I say, Always check your hospital policies regarding IV drugs! Secondly may I say here in the UK at the hospital were I work, we would not dilute. If the patient was not IVF We would flush with saline before and flush the line after, but if on IVF we would use that as our flush. Again its down to what your hospital guideline stipulates, and you should adhere to those guidelines in all cases, otherwise if you don't follow rules then you ask for trouble.

[Undecided7]

Everything is not always so black and white/right or wrong. Of course, check the policies and drug info if not familiar. Some drugs have to be given diluted, some slowly over a period of time, some don't mix and others do, etc. With most things though- it's just up to the nurses judgement in a way. Patients, IV lines, drugs, and situations vary and sometimes there is no stated RIGHT way or WRONG way. You'll get more comfortable as time goes on. I know in school, things are different. Once you get out of school though, you'll become more comfortable with "real world" nursing.