Okay, Dumb question=Diluting meds

Nurses General Nursing

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The threads about diluting phenergren and nexium reminded me. I want some tips.

For instance, if you give 12.5 of phenergren, the vial is 1 ml = 25 so you have to pull 1/2 a ml. We use syringes with the sharp tip plastic "needles". If I pull 1.2 cc to be accurate I would have to use either a TB 1 ml or a 3 cc syringe to get the right amt. of phenergren. Then I need to add 10 cc of saline. I cant transfer the drug to a larger syringe without loosing some. I cant start with a 10 cc saline filled syringe and squirt out 1/2 cc of saline accurately and fill it accurately with the phenergren. I cant accurately pul 1/2 cc in a 10 cc empty syringe and fill it with saline. What do you do??

If the whole amt (25CC or whatever) of the vial is to be used then of course there is no problem, I load the vial in an empty syringe and then draw up the saline to dilute it.

So far I have had to draw out 1/2 cc in a small syringe and waste it thus having the correct amt. left in the bottle to draw into a larger syringe. Is this the only way??? Help.

Same if I get an order for toradol 15 and all we have is 30 ml vials, etc. I cant imagine if the order is going to be 6.25 of that 25 cc vial.

Signed, Missing it somehow!!!

Draw up your NS, say in a 10ml syringe you would draw up 9mls NS then 1ml of phenergan 25mg/ml. If you were to give 12.5 mg, then just push 5ml of the diluted med and waste the rest or label it and put it in the patients med drawer for another dose later. I know with phenergan we want it more diluted than that, but the same principle applies.

Specializes in medical, telemetry, IMC.

here's what i do:

i use a 3ml syringe and draw up 0.5ml of phenergan into that syringe with a blunt "fill needle". then i squirt 0.5ml of ns out of a prefilled 10ml saline flush and after that i squirt the phenergan into the saline flush.

Specializes in Med/Surge, ER.

When I dilute Phenergan, I draw up 9ml of NS, and the 1ml of Phenergan (25mg/1ml) to equal 10ml. If my order is for 12.5mg, then I waste 5ml. If my order is for 6.25mg, then I waste 7.5ml. If you make it even, it makes it much easier. Same thing with Morphine. Our Morphine comes 10mg/1ml, so I draw up 9ml NS, and the 1ml of Morphine making my dilution 1mg/1ml.

Specializes in Postpartum.

Yeah, we have 3 ml. Its just that my brain couldnt figure out how to get it into a prefilled 10 cc syringe without losing some of it cause I was too thick headed to think of using a REAL needle rather than a blunt plastic one. DOY! :clown:

Its interesting to see how many people do things differently though.

Specializes in Rodeo Nursing (Neuro).
I know how much I NEED, problem is I cannot accurately measure .5 of a 1 cc vial in a 10 cc syringe, as another poster pointed out, the measurements are in increments of 2, 4, 6, etc. Could do 1 cc because there is a mark.

Anyway, I like Tazzi's suggestion, I forget about using a sharps needle to inject into a larger syringe hole. Always using those plastic things, you forget about sharps LOL.

In my carpenter days, I could routinely measure a board to about 1/16th of an inch, even though my measuring tape was graduated in 1/8ths, simply by going between two marks. If your dose is between .4 and .6 mls, it's almost certainly close enough. How else could the same dose be okay for a 60kg pt and a 100 kg patient?

On the other hand, Tazzi's plan would assure even greater accuracy.

You could probably confirm whether my assumption is valid by a call to your pharmacy. Hmm. I may just give mine a buzz, tonight.

I see it done a lot, but I really don't like to put meds into a prefilled dilutent. I'd rather put the dilutent into a plain syringe, and unless I'm actually at the bedside, I label it.

Labelling is a nuisance, but one time of getting called away from the med cart and having to re-draw the med because I couldn't be absolutely certain I was picking up the same syringe was enough to convince me.

Draw up your NS, say in a 10ml syringe you would draw up 9mls NS then 1ml of phenergan 25mg/ml. If you were to give 12.5 mg, then just push 5ml of the diluted med and waste the rest or label it and put it in the patients med drawer for another dose later. I know with phenergan we want it more diluted than that, but the same principle applies.

For those of you using this method, how do you ensure the drug is thoroughly mixed so that when you administer half, you are actually giving an accurate dose of the drug?

I prefer to draw up the exact dosage of drug in a 3 ml syringe, and then dilute with NS in a 10 ml syringe. That way I am confident I am giving the proper dosage.

Specializes in CCRN, CNRN, Flight Nurse.
For those of you using this method, how do you ensure the drug is thoroughly mixed so that when you administer half, you are actually giving an accurate dose of the drug?

After you've gotten your drug and dilutant into the same syringe, aspirate an additional 1-3ml of air to the syringe. Invert several times. I don't think you can mix it any more thorough. After mixing, tap out any remaining air bubbles and push out the air. Now you're ready for injection into the port of choice.

Specializes in Neuro ICU, Neuro/Trauma stepdown.

what's wrong with drawing up the med accurately, and then drawing up ns to fill the syringe?

I understand diluting phenergan. WithToradol, if the order is 15mg, and it is 30mg in 1ml vial, draw up .5ml for 15mg in a 3cc syringe for needleless port. The medbook states it may be given undiluted and administer through a free-flowing IV or through three way stopcock or y-tube . It CAN form a precipitate with drugs incompatible such as demerol, morphine and phenergan, so it seems very important it pre and post flush. Rate of administration recommended is a single dose over 1-2 minutes prefered. I would think the running IV fluid(if compatible) will also help dilute? So, this is what I get from looking up in the medbook for administration....Would love to hear the concensus out there on the floor and your hospital policy to dilute Toradol? We are now very careful to limit the amount of maximum Toradol daily due to it's NSAID property. This analgesic (non-steroidal anti-inflammatory) works really well when alternated with a narcotic for pain relief. Marty

Specializes in Emergency, outpatient.

I have not heard of anyone diluting Toradol; and you are right about making sure you flush well between meds. Have not had any complaints, but I do not put IVs in the hand unless it is the last resort.

I'm glad this is an old thread--one of our docs likes to give 10mg of Toradol; that would drive the OP crazy! And when I moved jobs recently, they were still using IM Toradol (the 60mg/2ml vial) for the IV route. It took one phone call and a couple of days later, a new IV Toradol was available in the Pyxis!

Thanks Northshore

I read an old thread that stated someone always diluted Toradol at their hospital? I also do not see Toradol routinely diluted but wondered what the best practice was?? Many nurses routinely dilute drugs in 10cc NS and others follow the IV drug books administration guide if determined safe to deliver undiluted with infusing IV but with specific duration. I am routinely checking with the IV book on the floor to confirm which drugs can be given undiluted. Thanks for the reminder regarding IM Toradol and to check carefully for IV medication route on vial... very true!!

Marty

Dear Northshore

How are you administering Reglan IV push? I am cautious with this drug due to side effects. I know my friend from the ER has physician orders for IVPB infusions. What is your practice in diluting and giving this medication slowing IV push. Marty

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