Quote from 7feetunder
thanx.we've been taught so..and the using of non-PVC bags if more than 2 hours is new to me.Thanx a lot.I've seen Amiodarone 150mg diluted in 50cc N.Saline over 0.9% and run over 10 minutes during my clinical.Being curious,I asked more than 5 staffs workin in ED and they give me the same answer.Can be diluted in N.saline.I just wont believe it.
It absolutely can be diluted with NS. That is how to administer your IVP dose in a code.
Maintenance doses need to be mixed in D5w.
The question is whether the initial loading dose of 150 mg can be mixed in 100 ml ns, as it often is.
According to Davis: No.
* Direct IV:
Administer undiluted. May also be diluted in 20-30 mL of D5W or 0.9% NaCl.
Administer IV push.
* Intermittent Infusion:
Dilute 150 mg of amiodarone in 100 mL of D5W. Infusion stable for 2 hr in PVC bag, or use pre-mixed bags.
Infuse over 10 min. Do not administer IV push.
* Continuous Infusion:
Dilute 900 mg (18 mL) of amiodarone in 500 mL of D5W. Infusion stable for 24 hr in glass or polyolefin bottle.
1.8 mg/mL. Concentration may range from 1-6 mg/mL (concentrations >2 mg/mL must be administered via central venous catheter).
Despite that, I believe it is a fairly common practice.
Let's say you are working a code, and getting drugs ready. Patient is a 10 kg baby. In anticipation of needing Amiodarone, you draw up 50 mg in 30 ml ns, and have at the ready for 10 minutes. 1.66mg/ml. (while this is not how I would draw it up, it would be within the guidelines.)
In the next bed, is a more stable guy getting a maintenance gtt, starting with a loading dose. 150 mg in 100 ml ns. 1.5mg/ml.
Similar concentrations for similar duration. The baby gets Amiodarone diluted with normal saline.
It is not always clear why a manufacturer makes certain recommendations. Lovenox in love handles for example: " Alternate injection sites daily between the left and right anterolateral and left and right posterolateral abdominal wall."
This makes no logical sense. Why not anterior abdomen? When I asked a Lovenox rep about this, I was told that since the initial studies were done using the sides, that was the recommendation. Absolutely no pharmacologic reason to do it.