How do you draw up meds for IVP?

[FineAgain]

I am curious...how do YOU draw up meds for IVP? For instance, if you have a vial of 1 mg/1ml of dilaudid, and you only want to give 0.4 mg/0.4 mL...how do you draw it up? I have seen nurses use a 3 mL syringe to draw up the 0.4 mL, the inject it into a NS flush; I have also seen nurses draw up the med, and inject it into a 10 mL syringe, change needles and draw NS into the syringe to mix it.

As a new med-surg nurse, I am curious as to what you consider best practice. I have looked online for information on this and find that practice varies there too!

[Sun0408, ASN, RN]

It varies. If the pt has IVF running, say NS, I draw what I need and push it in the port closest to the pt. If they are SL'ed, I draw up what I need and inject that amount in a 10cc NS syringe and give diluted slowly to avoid unwanted effects from giving too fast.. If they are getting all the contents of the medication (1mg/vial) I will waste some of my NS pre-filled syringe and draw up the med, then give..

[justchill, BSN, RN]

I almost always dilute all narcotic IVP meds, but in general if it needs to be diluted I go one of two ways.

1) If I'm using all of the dose from the bottle, I just put a needle on a flush and draw up. So our dilaudid comes in 1mg/1ml ampules so I just take a filter needle on a 10cc flush that I've already wasted about 3ml from and draw up with the flush with a filter needle

2) If I'm only using a partial dose from the vial and need to dilute, I use an empty syringe to draw up the amount needed then inject into a flush.

I dilute regardless of fluids running, especially if they have LR or something other than NS running, just gives me some peace of mind. If they don't have fluids running, I always bring an extra flush so it doesn't sit in the line at all.

[FineAgain]

Thanks guys! I generally draw it up, waste the rest and inject the needed portion into a flush. But I have seen people do it all sorts of ways and am curious as to how others do it.

[MunoRN, RN]

I draw it up and give it. How do you "inject it into a flush"?

[FineAgain]

A 10 cc saline flush

[KelRN215, BSN, RN]

It varies. If the pt has IVF running, say NS, I draw what I need and push it in the port closest to the pt. If they are SL'ed, I draw up what I need and inject that amount in a 10cc NS syringe and give diluted slowly to avoid unwanted effects from giving too fast.. If they are getting all the contents of the medication (1mg/vial) I will waste some of my NS pre-filled syringe and draw up the med, then give..

Same.

[TeachRNADN]

I happen to teach Peds and I always tell students, If you need to draw up a dosage that is less than 1 ml, always use a TB syringe. You can then inject your drug into a 5 ml saline syringe to further dilute. This allows you to administer the dosage ina slow controlled fashion. Diluting drugs means you need to make sure that the diluent is compatible with the medication and that your patient's specifics can tolerate the extra volume. For instance, you would not give that much diluent to a neonate. Give your med in the closest port to the patient and administer it according to the manufactors recomendations! Good luck!

[turnforthenurse, MSN, NP]

I draw it up and give it. How do you "inject it into a flush"?

I use a a needle (an actual needle, not a plastic or filter needle because it does not fit into the saline flush opening) and inject it into the flush that way. If I am withdrawing the full amount, I will just go ahead and draw it up into the flush.

[iluvivt, BSN, RN]

http://www.ismp.org/newsletters/nursing/Issues/NurseAdviseERR200702.pdf

Just want to add see page one and three about the use of NS prefills since you asked about best practice

[FineAgain]

Very interesting newsletter...and hence why I without fail, label my syringes. I don't want to take the chance that (a) I can't remember what is in it or (b) think it is a flush and use it -- ooops it wasn't (not going to happen!). Thanks for the link!

[Morainey, BSN, RN]

I use an empty 10 ml syringe with a fill needle, and draw up the medication into it. Then I draw from a vial of NS. If I have to give a precise amount of Dilaudid (0.2 or 0.5 mg) I draw that up in a 1 ml syringe and waste appropriately, then inject it into the 10 ml syringe, and draw up NS to dilute it. Labels, labels, labels people! I do all of this in the med room so I don't get distracted by the patient, their family members, etc.