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!

[Do-over, ASN, RN]

I only dilute meds that require it (Ativan, for example). I use the smallest syringe appropriate for the dose.

I am not a fan of adding medication to prefilled flushes. It doesn't seem safe to me. If you really want to dilute, it would seem (to me, without any actual research) that it would be safer and cheaper to pull back fluids from the running line or use a vial of saline to dilute.

As for PICC and central lines, if I have someone needing one of those, then I generally have a flush line running, or a cvp line to use.

[0.adamantite]

I only dilute meds that require it (Ativan, for example). I use the smallest syringe appropriate for the dose.

I am not a fan of adding medication to prefilled flushes. It doesn't seem safe to me. If you really want to dilute, it would seem (to me, without any actual research) that it would be safer and cheaper to pull back fluids from the running line or use a vial of saline to dilute.

As for PICC and central lines, if I have someone needing one of those, then I generally have a flush line running, or a cvp line to use.

This is genious and something I've never thought of before - diluting with fluids from the running line. So do you pinch off the part of the line running to the patient, and then draw back fluids from the bag? Actually this might require us to disconnect the line from the pump, which with our pumps seems more work than anything else =/

[boogalina, ADN, ASN, BSN, MSN, LPN]

If I'm going to withdraw the entire contents of a vial or Carpujet (sp?) and need to dilute the medication, I will waste 2 mL of the saline in a prefilled flush (since usually meds that need to be diluted come in 1 to 2 mL vials), then draw up the med into the flush.

I have tried drawing up saline from a vial after first drawing up the med to be diluted, but worry about having some of the med pulled into the diluent (and therefore not giving the correct dose).

I would never dilute a med with an unsealed (no plastic overwrap) saline flush or a previously opened vial of saline, though.

[Do-over, ASN, RN]

This is genious and something I've never thought of before - diluting with fluids from the running line. So do you pinch off the part of the line running to the patient, and then draw back fluids from the bag? Actually this might require us to disconnect the line from the pump, which with our pumps seems more work than anything else =/

I've never done it, I think someone else in this thread mentioned it. I only dilute when necessary - Ativan, for example. I do not dilute other meds and have had no problems administering them.

[Cinquefoil]

I've never done it I think someone else in this thread mentioned it. I only dilute when necessary - Ativan, for example. I do not dilute other meds and have had no problems administering them.[/quote']

I had a pharmacist at our hospital tell me never to dilute Ativan, because occasionally it crystallizes out of solution when diluted.

What's the case for diluting it?

[Do-over, ASN, RN]

Pharmacy instructs us to dilute 1:1, I believe the package insert does as well.

[GundeRN]

I haven't ever diluted ativan, and don't think I have ever seen anyone else do either. I will have to call my pharmacy about this one.

[NanikRN]

I haven't ever diluted ativan and don't think I have ever seen anyone else do either. I will have to call my pharmacy about this one.[/quote']

Ativan is a very thick solution. I've always diluted 1:1 minimum

[NanikRN]

Ativan is a very thick solution. I've always diluted 1:1 minimum

Sorry. Just noticed this is old thread

[WHODEYzach]

Depends on the med. If it's Dilaudid and the order calls for 0.5mg and the vial is 1mg per 1ml then I usually use a 0.5ml insulin needle to draw it up and then I inject it into a flush.

But for a drug like Ativan an insulin needle wouldn't work because Ativan is too thick and viscous for an insulin needle. Let's say my order calls for 1mg Ativan and the vial is 2mg per 1ml. In this case, I use a plastic safety needle and draw up 0.5ml in a 3ml syringe. I then switch from the safety needle and use a 20g needle and inject the Ativan into a flush.

But I dilute just about everything unless the order tells me not to. Like Reglan for example.

[FineAgain]

I asked because...people say you shouldn't dilute with a flush because technically they aren't sterile. Well, if they aren't sterile, why are we injecting them into a vein to flush? And if they are sterile, why can't we use them for IVP? I decided that MY best practice is to not dilute everything and use the 'Y' port...very slowly, flushing before and after.

[Cinquefoil]

According to my understanding which I owe to your post:

There are sterile flushes and non-sterile flushes. Sterile flushes will be labeled as sterile instead of the regular ones which will just be labelled "sterile barrel" or such. Sterile flushes can be placed on a sterile field; "partially sterile" ones such as those usually used are only sterile under the cap at the tip and inside to where the plunger originally meets the liquid. These may not be used on a sterile field.

If medications are diluted within "partially sterile" flushes using aseptic technique, they do stand a risk of being contaminated, especially if the flush plunger is pulled back farther than the original fluid fill point or if there are germs on the outside of the plunger at any time due to aseptic technique's lack of sterility.

In addition, if we do dilute by any method, we should always follow an evidence-based guide and pharmacy policy on which meds to dilute in what.

Is this a fair summary?

You raised a GREAT question. Made me look closer at labels on everything in my workplace, at my practice, and at my facility's practice. Please keep asking!