IV Medication Administration

[audrey_]

I'm a nursing student in my second year of the RN program and I am having such a difficult time with IV reconstitution and it's really discouraging me in this program.

I'm mainly just having a hard time really grasping how to read and know what numbers to pull from the parenteral drug manuals, and I'm not sure how to figure out what size IV fluid bag to then put the reconstituted medication in. I haven't had the opportunity to do many IV meds throughout my clinicals thus far and I don't feel like my school has put much effort into actually teaching us how to read parenteral manuals but instead just put us through medication administration exams which I don't struggle with at all but somehow only struggle when reading the actual manual.

Can anyone help me with this or know of any good videos out there that can help me grasp this concept?

[ruralnurse84]

I work in a small hospital in the states and we have to reconstitute most of our drugs ourselves but it's already entered in as an order to what bag size it gets reconstituted with. On the rare occasion that this does not happen I just look it up in the IV drug manual we have on the floor. That will tell you what size bag you need. Zosyn at our facility is commonly mixed in 50 ml bags. In fact I just mixed some up tonight.

[audrey_]

yes I've heard of Lexicomp, I'm going to go through it and try to get more comfortable with some of the IV monographs & I will definitely try to request patients with more IV medications to get more practice! Thank you everyone for taking the time to respond! :)

[smf0903]

I work nights in a small hospital and we do not have pharmacy there after 21:00. We reconstitute everything for any new admits (meds that have yet to be profiled by pharmacy). You should have an IV manual available to you. In a pinch we look at the order to see what to reconstitute in (200mL/hr infuse in 30 minutes is a 100mL bag). Drips we have a manual made by our facility that is a step-by-step...if we remove any from the bag before adding the medication, if the reconstituted bag can only hang for x amount of hours, any special tubing needed, stuff like that.

[Lev, MSN, RN, NP]

The only meds i'm reconstituting is protonix with normal saline and zyprexa with sterile water. Oh, and now that there is an IV bag shortage, pharmacy is sending some of the IV antibiotics (like rocephin) to be given IV push, but they are send in a bag with the vial of normal saline and instructions.

[Here.I.Stand, BSN, RN]

also, after having reconstituted the med. how do you determine what size mini bag you use? is there a particular calculation you do to figure that out or is that purely just based on nursing judgement?

You look up the med. The drug manual/online pharmacy resources would tell you that Zosyn should be mixed in 100 ml. So you grab a 100 ml bag. My facilities have had 50/100 ml bags with a connector that snaps over the med vial, but if you don't have those you can inject NS from a prefilled syringe into the vial and then transfer it into the minibag. Just remember that if you use 10 ml, the minibag now has 110 ml -- not 100; you'd need to set your VTBI as 110 ml.

Repeat with any other IV med.

[Orion81RN]

This is why I love pharmacists. If we don't have the med already reconstituted, I just call the pharmacy and ask. They let me know how much saline to mix it with. Lets say an ABT in powder form. They will say to draw up about 10 ml sterile water, mix it with the powder and inject it into the size IV bag they specify. Usually 250 ml or 500 ml NS.