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...

[Mish56, BSN, RN]

Although I've only been a psych RN 30 years, the "which doesn't mix?" question comes up time and again. We give alot of 5-2-1 ie: Haldol 5 mg/Ativan 2 mg/Cogentin 1 mg IM in emergencies. Irrelevant of where, or how many cc's, the pharmacist we work with gave the clearest yet answer!

Don't mix cogentin with anything. Period, end of story.

Now as far as where....I've given IM Haldol in deltoid a million times, often have zero choice. The rule is no more than 1 cc in deltoid, but in a larger person, I've given more. When you have 8 people holding one down, getting the right muscle (ie: not another employee LOL) is not as critical as getting the medication in.

As far as waiting to give PO cogentin, if you've never seen an acute dystonic reaction you might wait, but believe me, I won't! And haldol is the highest culprit. Nothing like seeing a real person re-enact the "Exorsist" scene when Linda Blairs head turns around, to make you feel just fine about giving IM cogentin, although I prefer benedryl. I have seen a doc give IV stat benedryl during an acute reaction, works like a charm!

[Karenj2k]

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?

Cloudy, Clear, Clear, Cloudy....clean the vials, Air into cloudy then clear, draw up clear then cloudy.

[elkpark]

Although I've only been a psych RN 30 years, the "which doesn't mix?" question comes up time and again. We give alot of 5-2-1 ie: Haldol 5 mg/Ativan 2 mg/Cogentin 1 mg IM in emergencies. Irrelevant of where, or how many cc's, the pharmacist we work with gave the clearest yet answer!

Don't mix cogentin with anything. Period, end of story.

Now as far as where....I've given IM Haldol in deltoid a million times, often have zero choice. The rule is no more than 1 cc in deltoid, but in a larger person, I've given more. When you have 8 people holding one down, getting the right muscle (ie: not another employee LOL) is not as critical as getting the medication in.

As far as waiting to give PO cogentin, if you've never seen an acute dystonic reaction you might wait, but believe me, I won't! And haldol is the highest culprit. Nothing like seeing a real person re-enact the "Exorsist" scene when Linda Blairs head turns around, to make you feel just fine about giving IM cogentin, although I prefer benedryl. I have seen a doc give IV stat benedryl during an acute reaction, works like a charm!

Ditto.

I don't mix Cogentin with anything. And it's entirely possible for someone who has gotten a big dose of IM Haldol to develop a severe dystonic reaction before po Cogentin gets given and kicks in. My personal preference is to "match routes" -- i.e., po Cogentin with po Haldol, but IM Cogentin if the Haldol is given IM.

[Kooky Korky, 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.

I hate to tell you but Pharmacists don't always know either. Try this - www.rphworld.com/viewlink-22961.html for a chart of syringe compatibilities (use within 15 minutes).

[drmorton2b]

I agree with Mish56. Plus if one has to give an IM to a patient them more then likely at that point they aren't compliant with the PO meds anyway. Haldol IM is almost always given with IM Cogentin or Bendaryl IM

.

[oneLoneNurse]

We don't have IM cogentin and don't think I have ever given it. I know we cannot mix benadryl and haldol as it would crystalize. Experienced nurses here, told me to give it together too, but I asked the pharmacist. I am an experienced nurse who just hasn't been lulled into not asking questions yet.

[NurseCubanitaRN2b, BSN, RN]

We don't have IM cogentin and don't think I have ever given it. I know we cannot mix benadryl and haldol as it would crystalize. Experienced nurses here, told me to give it together too, but I asked the pharmacist. I am an experienced nurse who just hasn't been lulled into not asking questions yet.

You mean mixing benadryl & haldol in the same syringe? I've never given both in the same syringe but I have given at the sametime in different injection sites.