Haldol and cogentin IM

[New2ER]

I gave a patient haldol and cogentin IM. I mixed it in two syringes since it was too much liquid for just one shot (4 cc total). Each had some 1 cc of haldol and 1 cc of cogentin. The first shot went in just fine. When I gave the second shot I noted that just prior to injecting, the fluid had formed precipitate.

I've never given cogentin and haldol together (usually give haldol and benadryl), was I not supposed to mix it? I asked 2 other nurses just prior to drawing up the med, and both said mixing the two was fine. I wonder now...

[Thunderwolf, MSN, RN]

No, it is not OK to mix the two in the same syringe....you saw the result first hand.

[PsychNurseWannaBe, BSN, RN]

Good question! Also a great learning experience with asking other nurses. I have found that "seasoned" nurses take short cuts that I know should not be done. I learned that leason and now I always carry a drug book with me. I refer to that before asking.

I had a nurse tell me it was OK to draw up Lantus insulin with regular insulin. After I explained why this is not to be done... she rolled her eyes at me.

Kudos to you for asking on this site even though 2 nurses at your job said it was OK.

[PRNMEDS]

I have never heard of it being contraindicated. I am pretty sure have given (though can't recall when). Did you check med book? I know Benadryl and Cogentin are contraindicated but don't see how cogentin and Haldol are.

[Roseyposey]

Okay. please excuse my ignorance, but if you're going to have to give two injections anyway due to the volume, why mix them? The only times I have combined drugs when giving injections is to save the patient a poke.

[helper T cell]

I had to give this shot this week. My pharmacist told me that mixing the two would cause crystalization if let to stand over 20-30 minutes. He said that as long as I gave the shot right away it was ok. The dose i was required to give was a total of 3ml. My drug book said give in large thigh muscle vastus lateralis or gluteus site near greater trochator. Why can't we use the deltoid for haldol?

Thanks from a 1st year med surg nurse.

[inthesky]

I always give the extra poke for my own peace of mind =P. If I can't remember whether the insulin is drawn up clear before cloudy..whatever.. two shots.. patient safe. period. Maybe this is part of my newbieness?

[medsurgrnco, BSN, RN]

Can't answer your questioni regarding mixing those meds. But I don't trust asking other nurses. I would look the info up in a drug book or call a pharmacist.

[Jules A, MSN]

I give two shots and this might sound really stupid but I have wondered why we can't give the Haldol IM then the Cogentin PO after they are calm?

[green12, BSN, RN]

JulesA- I can think of quite a few reasons but the first that comes to mind is that you don't want someone having EPS/dystonia in the midst of their behavioral crisis, they don't always calm down as quickly as we would like. I recently had a patient acting out for 7 hours who needed PO meds and 2 IMs before calming down.

I have given Haldol in the deltoid on rare occasions (1ml). Any contraindications to this?

[medsurgrnco, BSN, RN]

I give two shots and this might sound really stupid but I have wondered why we can't give the Haldol IM then the Cogentin PO after they are calm?

Maybe some patients would become too sedated to take PO meds?

[Jules A, MSN]

Maybe some patients would become too sedated to take PO meds?

Possibly although it seems like I give enough meds to sedate an elephant and yet it only brings my patients down to their baseline for 1/2 hour! :) I guess I didn't realize that dystonia could/would start so quickly after the administration of a single dose of Haldol.