Dilutions/ Med Info

[NewNurse_20, BSN, RN]

For some background info: I am a new graduate nurse working in a level II trauma center. I have been a nurse for a whopping total of 8 months. I've learned a ton already, but there is still so much to learn!

I was recently talking to one of our far more experienced nurses about diluting medications. She told me there are some medications that she always dilutes due to patient reaction, such as Reglan, Pepcid, Phenergan, Ativan, etc. Now I usually dilute Ativan (unless it's a wild psych patient and I'm giving it IM in a HURRY!) and I have always diluted Phenergan. But I had no idea about the Reglan or Pepcid! 

I would like to call on the experience of you lovely nurses and see what else you recommend diluting or any other medication information I should know (for ex, I know pushing Decadron too fast IV will cause some serious butthole burn!) I love learning best practices, especially from those far more experienced than I! Please comment and teach me some things!

[Guest219794]

Phenergan?  It's unusual to give phenergan IV.  Used to be common, forbidden in most places now.

Diluting is a common practice, but not best practice.  I do it.  Experts on the subject say it shouldn't generally be done.

Tackling the dangers of unnecessary I.V. dilution

Check out page 22.  Mostly taken from this source.

There is a lot of stuff we nurses do base on "I was taught this way", or I have always done it this way."
Both of those are poor rationale for doing something.

[RETNAVYTHENMEDIC2RN, ADN, RN, EMT-P]

On 9/19/2021 at 12:50 AM, NewNurse_20 said:

For some background info: I am a new graduate nurse working in a level II trauma center. I have been a nurse for a whopping total of 8 months. I've learned a ton already, but there is still so much to learn!

I was recently talking to one of our far more experienced nurses about diluting medications. She told me there are some medications that she always dilutes due to patient reaction, such as Reglan, Pepcid, Phenergan, Ativan, etc. Now I usually dilute Ativan (unless it's a wild psych patient and I'm giving it IM in a HURRY!) and I have always diluted Phenergan. But I had no idea about the Reglan or Pepcid! 

I would like to call on the experience of you lovely nurses and see what else you recommend diluting or any other medication information I should know (for ex, I know pushing Decadron too fast IV will cause some serious butthole burn!) I love learning best practices, especially from those far more experienced than I! Please comment and teach me some things!

When in doubt, consult the Pharm D. He or she is the expert who is qualified to answer the question regarding medications and their administration. I know in our EMR system EPIC I can look in the MAR for each medication for administration  questions as well. Asking other RN's is nice but can also be a roll of the dice depending on whom you ask. 

[iluvivt, BSN, RN]

That's correct,You should not dilute anything unless a credible source states it is acceptable.My favorite IV medication course will always be:

Intravenous Medications: A Handbook for Nurses and Allied Health Professionals

Book by Adrienne R. Nazareno and Betty L. Gahart.   Check it out....The best!                                       Also some think that if you dilute an IV medication that it is less irritating to the tunica intima of the vein but this is not always true.Many medications are inherently irritating and it makes no difference whatsoever.

[Music in My Heart]

The only thing I dilute is famotidine and that's because pharmacy specifically directs us to.

Up until a few years ago, I did dilute phenergan, too, but they've taken IV phenergan off of the formulary at my facilities... too many nurses pushing the stuff into sketchy lines.