giving meds that are less than 0.1 cc

[nicu4me]

Hi, just wondered if your facilities dilute medications with NS or sterile water if they are in less than 1/10th of a cc/ml. I had an iv med that was for 0.08 cc. This is a pre drawn up med from pharmacy, not one that I would have drawn up. I understand that our babes cannot take on extra fluid that they don't need but giving it in a TB syringe that holds 1.0 cc/ml just doesn't see very accurate. Also the med properties may not be able to be diluted to be effective either. I also think what if some of it squirted out while getting it connected to the med line, you could lose it all and not know it (not that it did). The med line itself holds 0.3 cc, so I know that 0.5 cc of 1/4 or 1/2 NS flush is what's going to be timed out longer than the push. Any examples or help from anyone would be appreciated.

[300g]

What was the med? We deal with tiny numbers in our tiny population... you just have to be very careful.

I gave a dose of caffeine the other day (750gm, 10mg/kg, 20mg/ml) and the dose was 0.375ml. We double check caffeine with another RN. I grabbed a fresh off orientation RN and asked her to verify the 0.005ml because I had a tough time seeing it without my glasses... :chuckle

(I don't wear glasses)

[nicu4me]

methadone

[nicu4me]

what size syringe are you able to give 0.005cc with safely? You have to draw up your caffeine or does the pharm?

[dawnebeth]

On doses that are less than 0.1ml, we do one to ten dilutions (or even 1 to 100 dilutions for doses that are 0.001ml). For some drug that is being weaned, say betamethasone, and the dose is 0.02ml, take 0.1ml of the med and 0.9ml of sterile water and mix the two together, then draw up 0.2ml of the mixture to give to the baby. That can be further diluted with more sterile water to make it easier to go on a syringe pump.

Sometimes the pharmacy has already done a dilution for us, but a lot of the time they don't. They do send us special multidose syringes of morphine that are already mixed like that to keep in the narc box.

Dawn

[twinkletoes53]

We dilute our meds that are in micro-doses. The easiest way I have found to do this is to have a second 1ml syringe ready, with approximately 0.3ml of NS in it. For example, if the dose of meds. that you are giving is 0.05 ml, take this syringe with the medication in it, and squirt the drug into the 2nd syringe, which has your NS. That will make your total medication dose to equal 0.35ml. Much more accurate to give via a syringe pump.

BTW, you CANNOT "pull back" the medication in the syringe that the drug came in, and add NS to it. The "dead space" in a syringe is approximately 0.05ml. So if you "pulled back" the drug in your original syringe to add NS to it, you will see that the total dose of the medication you are giving has been doubled.

[300g]

what size syringe are you able to give 0.005cc with safely? You have to draw up your caffeine or does the pharm?

Sorry for the confusion... it was a real situation, but I was joking with the other nurse. It's impossible to measure 0.005ml but our pharmacy sends it that way.

As the others have said, there are two general ways you can dilute with a compatible diluent. Add the med to another syringe with a prefilled amount of diluent... or, dilute 0.1ml in 0.9ml diluent and move your dose decimal one place to the "right". :)

(like they said... but more confusing.)

I honestly cannot think of a med we use in the NICU that you can't dilute... but I'm sure there's one out there somewhere...

[Florida NICU RN]

I can't remember giving anything less than 0.01 and if it's 0.5 or less (like Caffeine at times), I push it into the line and put up a 1ml flush. In the instances where I've diluted, I dilute 0.1ml with 0.9ml NS flush (if compatible) and move the decimal over to the right (0.02 becomes 0.2).