Diluting pain medication?

[coffeeandvendingmachines, BSN]

Hello all, 

 I have many fellow coworkers who will dilute IV pain medication every time they administer it. "I always dilute my meds" "I won't give the patient a high/rush" "Doesn't the package even say to dilute it? I've always done it".  Well, the last time I looked at the Dilaudid package I don't recall instructions to dilute. One nurse with an opposite opinion voiced, "If you dilute it, does it really work?"/ "Is it effective?" So I'm asking the allnurses community, as you've probably been asking a thousand times before, 

 

Is it proper nursing practice to dilute IV push pain medications? If so, why? What does the manufacturer package instructions indicate? If not, why not? 

 

[Emergent, RN]

Either/or is fine. I usually don't,  mainly to avoid the extra step. Sometimes will, to give more gently to a more sensitive person. 

[JKL33]

My opinion is that it doesn't matter the majority of the time as long as no other important principles are violated during the course of the nurse's actions. I now only dilute things in the syringe if I am pushing them into a saline lock or the dilution is specifically instructed or recommended by manufacturer.

Understand that if there is a running IV and especially if it is at any significant rate, the meds are being diluted on the way in; it isn't as if dilution itself is typically harmful. Not that I've ever heard anyway.

Personally I don't think any of it matters to an extent that is worth the amount of arguing that has been done about it.

[NRSKarenRN, BSN, RN]

Institute for Safe Medication Practices recommends AGAINST routinely diluting IV Push meds.

2014:  Some IV Medications Are Diluted Unnecessarily in Patient Care Areas, Creating Undue Risk

2015: ISMP Safe Practice Guidelines for Adult IV Push Medications

2018 powerpoint: Replacing Old Practices with New Paradigms: Adopting Safe Practices for IV Push Medication

2019: American Nurse Today -  I .V. Push Medication Administration

[NicelySeasoned]

I am glad to see your logic Karen. I was getting ready to go to the ISMP site until I scrolled down. Another issue is what does your facility policy say about this? And your Pharmacy? Joint Commission loves to ask where the policy is that allows you to do this and where your competency is. 

Safe Practice nurses.

[pinkdoves, BSN]

I actually ran into something similar yesterday. Not a pain med but IV benadryl. I had no idea this med was particularly irritating to the vein. My patient was screaming on the top of his lungs when I gave it without diluting. I looked in the medication info section and nowhere did it say to dilute med. all the senior nurses told me I should next time (I guess now I know) but how would I know that if it is written nowhere? I guess you just have to experience some things

[NicelySeasoned]

The ISMP links that were posted above will tell you that unfortunately there is no real standard for dilution of IV push meds. However, check with your pharmacy for advice. Also, look up the drug. There may not be dilution advice but in your case, Benadryl (diphenhydramine) has a ph of 5-6. Enough to burn if given to fast or too close to the site.