Help with diluting meds for IVP

Chewie_123 · Mar 23, 2010

For the purpose of nursing school, do what your instructor tells you. And this does sound like the most correct way to do things. Don't forget to switch the filter needle out before adding to the NS.

In reality, most nurses I work with and myself draw 2/1 dilaudid straight into the NS through a filter needle. Lets face it, another .2mg or whatever probably isn't going to do hurt the patient, and anything larger than a 1mL sryringe is going to be a little inaccurate anyway.

For anything in a higher concentration though, I always draw up with a smaller syringe.

IVRUS, BSN, RN · Mar 29, 2010

Hi! I need some help!! I have been completely beside myself after clinicals today and I just need some advice from other nurses!
Ok, my patient I was assigned today went home so at the last minute my instructor gave me a patient to administer a medication to. The new patient was ordered Dilaudid 2mg/1mL IVP. After veryifying orders, I began looking up the drug to work out my calculations.
The drug book states it can be given undiluted, but with it being only 1 mL, I chose to dilute with 5 mL of NS in order to push 6 mL over 4 minutes, or 0.40 mL over 15 seconds.
My plan was to use a 10 mL syringe with NS, discard 5 mL and draw up my dilaudid from the glass vial.
The instructor gave me the go ahead and I began to do this. Well, as I am finishing adding the Dilaudid to my syringe, she tells me that I have done this incorrectly and I need to stop.
I freak out! I step back and begin to walk through the steps I have just done! I have given this drug with other instructors on numerous occasions and I knew that I had done the correct steps.
She goes on to tell me that I should have done the following way:
1. Draw up the Dilaudid in a 3 mL syringe (due to the fact that there is about 1/10 more Dilaudid in the glass vial and I have to waste it) ?? I have never been told this!
2. Use my 10mL NS syringe and waste the 5 mL
3. With the needle on the Dilaudid syringe, add the medication to the NS syringe.
Is this the way that it is done? I am trying to figure out if I was taught incorrectly and this is really how to mix this medication (and any medication in a vial).
Sorry for the long post! I have never received a "U" on medication administration ever and I am upset!
Thanks!!

Wow, I bet the instructor was an "old" one, or "old school" anyway. I too would have wasted 5 cc out of a prefilled 10 ml syringe, attached a filter needle or filter straw and then draw up the Dilaudid from the vial. Then, I would have discarded the filter needle and give the medication over the recommended time frame. The reason I say that the instructor must be "old school" is because in "olden" days, we did it just as she said... However, it is now known that transferring one medication from a syringe to another exponentially increases contaminant risks and SHOULD NOT be done!!!

Doesn't it feel great to know more than your current instructor!! :lol2:

morte, LPN, LVN · Mar 29, 2010

actually, i was under the impression you shouldn't use a prefilled NS syringe....that if you put it down someone may confuse it with plain NS.....an unmarked 10 ml syringe would be the better choice, drawing up saline then med.....if the dilaudid is in prefilled syringes instead of vials there is a problem. there is no way i would do it you instructors way unless there was no other way to do it.....

IVRUS, BSN, RN · Mar 30, 2010

actually, i was under the impression you shouldn't use a prefilled NS syringe....that if you put it down someone may confuse it with plain NS.....an unmarked 10 ml syringe would be the better choice, drawing up saline then med.....if the dilaudid is in prefilled syringes instead of vials there is a problem. there is no way i would do it you instructors way unless there was no other way to do it.....

Why would you put it down???

Once you draw up the medication.. GIVE IT.

And whose to say that a 10cc syringe filled with NSS and dilaudid won't be confused for just saline as well... Therefore, DO NOT lay the syringe down.. You drew it up, now give it. If for some weird reason you must lay it down.. Label the syringe so there is NO confusion!

BluegrassRN · Mar 30, 2010

I believe it is a Joint requirement that you do not draw another med into a prefilled, labeled syringe. It *IS* poor practice. You think you're going to give it immediately? What if the pt in the next bed codes as you walk into the room? Things like that happen.

However, it's easily remedied. At least at our facility, all those little pre-labeled, prefilled syringes have labels that pull off very easily. I would have pulled off the label, pulled the med into the prefilled syringe, labeled it, and gone on my way.