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!

[edmia, BSN, RN]

Interesting! I find all this drawing up into different syringes scary and a recipe for disaster.

I draw up the appropriate amount, clean the port I'm using, infuse the med, and flush.

If the whole 1 mg is to be given (in the example of 1mg/1 ml vial) I draw it up with a 3 ml syringe. If it's a carpujet then even better! No need to transfer and make mistakes. Just connect it directly to the IV port and push.

If it is a smaller dose, I use a 1 ml syringe and draw up the exact dose.

There is no need to dilute when giving such small doses. Maybe I will dilute if the patient is opiate naive and getting their first dose of something like 4 mg of dilaudid. But that's kind of rare. Most hospitalize patients are not opiate naive.

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[blueyesue]

Interesting! I find all this drawing up into different syringes scary and a recipe for disaster.

I draw up the appropriate amount, clean the port I'm using, infuse the med, and flush.

If the whole 1 mg is to be given (in the example of 1mg/1 ml vial) I draw it up with a 3 ml syringe. If it's a carpujet then even better! No need to transfer and make mistakes. Just connect it directly to the IV port and push.

If it is a smaller dose, I use a 1 ml syringe and draw up the exact dose.

There is no need to dilute when giving such small doses. Maybe I will dilute if the patient is opiate naive and getting their first dose of something like 4 mg of dilaudid. But that's kind of rare. Most hospitalize patients are not opiate naive.

Sent from my iPhone using allnurses.com

That's how I was trained. If fluids are not infusing I flush, push the med, flush. If fluids are infusing I just push. (all things being compatable of course) :)

[NCRNMDM, ASN, RN]

I draw the dosage of the medication up (in this case 0.4 ml), and then squirt enough NS out of a flush to fit that dose of medication into the flush. In this case, I would squirt out less than 1 ml of a 10 ml syringe of NS. I completed my preceptorship in a trauma center/ED, and I was always taught that you stopped all IV fluids when giving a push, so as not to bolus the patient. When I administer the medication, I stop the IV fluids, give my med mixed with NS, and then flush with a 10 ml NS flush. After that, I turn the IV fluids back on at the rate they were infusing at.

[MunoRN, RN]

I draw the dosage of the medication up (in this case 0.4 ml), and then squirt enough NS out of a flush to fit that dose of medication into the flush. In this case, I would squirt out less than 1 ml of a 10 ml syringe of NS. I completed my preceptorship in a trauma center/ED, and I was always taught that you stopped all IV fluids when giving a push, so as not to bolus the patient. When I administer the medication, I stop the IV fluids, give my med mixed with NS, and then flush with a 10 ml NS flush. After that, I turn the IV fluids back on at the rate they were infusing at.

I'm not getting why stopping the fluids prevents bolusing a patient with whatever is downstream of where you are pushing.

[Cinquefoil]

3 reasons I've been given for diluting with compatible fluid, with editorial comments:

1) Vasoactive substances. Examples: morphine and ondansetron, can hurt vein because of properties of undiluted med, dilution softens the impact. Or is this a myth?

2) Easier to time the IV push appropriately. I mean, sure, I could push 1 mg/1 mL undiluted Dilaudid over the recommended 3-5 minutes to help my patient avoid the feeling of head rush from H*ll and possible side effect of paralyzing the chest wall?...maybe...depending on how my motor skills are doing that day. But 1 mL of Dilaudid diluted into 6 mL normal saline, pushed over 3-5 mins? Heck yes, my motor skills can handle that one, even when I'm hungry and exhausted.

3) Pushing into a PICC, since using a

On the other hand, maybe don't dilute (unless necessary) if you know in advance that you're not going to look up the compatibility between the med and NS?

[Cinquefoil]

But I'm not happy to learn that the process of NS dilution using flushes may contaminate the flush...thank you for sharing that article, and bleepity bleep if it's true!

[DesertRN2009]

I draw it into a 3ml. I flush half ns then med slowly then flush ns.

[CherryAmes_RN]

For narcs I use a 3ml syringe to draw it up, draw a couple of ml NS from a flush unless they've got fluids going & then I just push slow into the lowest port without disconnecting. Cardiac meds I draw up with a 3ml but inject that into a flush after getting rid of the appropriate amount of NS and LABEL it. Of course flush-push-flush if it's a lock.

[JustAddCoffee]

Thanks for the article link. I've never seen a sterile NS flush that didn't come prepackaged in plastic. I would NEVER use one that I hadn't taken out of the wrapper myself, so I don't see myself accidentally giving a med that someone else had drawn up. If I'm going to be giving more that one med by IVP I label the the syringe once I've pulled them up so I don't mix them up.

I always dilute my IVP in a 10 ml NS flush. If I have a 2mg/ml vial of Dilaudid but am only giving 1mg, then I use an empty 3ml syringe to pull up the 2ml, waste half of it, and then pull it into a 10ml NS flush with a blunt tip needle to dilute. If the patient has compatible fluids with no potent meds in it I usually don't do a pre-flush. I give the dilaudid slowly, and follow with a slow NS flush. Why slow? Well, a good portion of the dilaudid is still in the tubing. I'm not going to slowly give the dilaudid only to slam the last bit of it with a fast push. If the patient has been INT'd I flush with NS, give the med slowly, and flush again.

[2bTraumaRN2008]

All of our narcs are in a carpujet. We waste directly from there if we need to and push directly from it, no diluting. I flush with 3 ml of NS only if they do not have IV fluids infusing. If fluids are infusing, they actually do the "flushing."

[TrissRN726]

For your example of giving o.4ml of dilaudid, I found it easy to use a 1ml syringe for drawing up the medication. Prior to administration I would flush the IV with about 5ml NS from a prefilled syringe, administer the IVP, then flush with another 5ml NS.

[benmca13]

I had no idea there was more than one way to draw up these meds!! I always draw them up into a syringe without diluting them! What's the point in that? Can't you just give the med slower? I've never had problems! I flush with 5mL saline, give the med over 1-2 min (3-5 if it's a pain med) and then flush with the remaining 5mL slowly.