Hydralazine question

When I worked L&D we gave 10 mg at a time and checked BP q 5 min x 20 min. RN stays at bedside. It is a little more predictable than labetalol IMHO. If there is a continuous IV it goes in the port farthest from the patient, over 30 seconds, and reaches the patient in a little over a minute. BUT it was reserved for DBP of 110 or greater.

When I worked L&D we gave 10 mg at a time and checked BP q 5 min x 20 min. RN stays at bedside. It is a little more predictable than labetalol IMHO. If there is a continuous IV it goes in the port farthest from the patient, over 30 seconds, and reaches the patient in a little over a minute. BUT it was reserved for DBP of 110 or greater.

This is a drug we use every day in anesthesia and its easy and cheaper to dilute it with whatever IV solution is running and then push the 5 mg. There is absolutely no advantage taking a full minute to push only 5 mg. of hydralazine.

it comes 20mg in 1 cc some people dilute it with 4 cc nss and then push 5 mg at a time. I have given 10 mg at a time.

This drug comes in handy with people who wont tolerate beta blockers.

Thanks for the replies. I know why and the doses--was mostly interested in the actually administration and dilution. I like the idea of the 5mg/1cc dilution. Thanks!

here in the hospital i'm currently working in, we do not dilute hydralazine with any solution. We just administer it directly through IV in just a few seconds. We do not receive any comments from the doctors, even they do the same thing. If it isn't right, then why do MDs do not know about that? Now i'm confused. Think I have to read more on that.

I recently had to give hydralizine 10mg for an elevated BP ....the drug orders said IM or IV.........I asked the pharmacist and he said its ok to give IM....we can not push IV meds and CT surg was not coming to the floor to push so it was given IM ..........has anyone else given it IM........

Angela

here in the hospital i'm currently working in, we do not dilute hydralazine with any solution. We just administer it directly through IV in just a few seconds. We do not receive any comments from the doctors, even they do the same thing. If it isn't right, then why do MDs do not know about that? Now i'm confused. Think I have to read more on that.

I think you misunderstood my original post. The Davis drug book says NOT to dilute it. I am just a little unsure of how people are pushing 0.25ml (5mg of a 20mg/ml solution) accurately. Especially in an emergency type situation. We only have 20mg/ml vials available and according to the drug book, that is the only way it comes for IV/IM administration.

So, when you give it undiluted, do you use a 1cc syringe? Do you have needleless systems? Do they have 1cc syringes with lure locks? I'm curious about the actual logistics of administration--I understand the reason to give, the dosage and the actions. You are giving it correctly undiluted!

Do not know if this answer your question but at my job we have a 1cc syringe that is smaller than the regular 1cc syringe that has the units divided in 0.25,0.50 etc so you can accurately draw up the amount

I think you misunderstood my original post. The Davis drug book says NOT to dilute it. I am just a little unsure of how people are pushing 0.25ml (5mg of a 20mg/ml solution) accurately. Especially in an emergency type situation. We only have 20mg/ml vials available and according to the drug book, that is the only way it comes for IV/IM administration.

So, when you give it undiluted, do you use a 1cc syringe? Do you have needleless systems? Do they have 1cc syringes with lure locks? I'm curious about the actual logistics of administration--I understand the reason to give, the dosage and the actions. You are giving it correctly undiluted!

Honestly, in real life you don't have to push it over exactly 60 seconds AND if you need to dilute it to 1 cc to make it easier then that is OK...it won't hurt anything. The pt who needs this drug already has a main line running, so it would end up diluted anyway. You don't want to slam it in, just push it slow and watch VS. I have not seen it bottom out the BP in a PIH pt who is sick enough to need it. And I use whatever syringe/needle/needleless I have available, I then draw up enough NS to make it easier to push slow (maybe 1-3 cc's) and then give it.

Honestly, in real life you don't have to push it over exactly 60 seconds AND if you need to dilute it to 1 cc to make it easier then that is OK...it won't hurt anything. The pt who needs this drug already has a main line running, so it would end up diluted anyway. You don't want to slam it in, just push it slow and watch VS. I have not seen it bottom out the BP in a PIH pt who is sick enough to need it. And I use whatever syringe/needle/needleless I have available, I then draw up enough NS to make it easier to push slow (maybe 1-3 cc's) and then give it.

Thanks- this was my thought as well. I appreciate all the of responses. I feel much more comfortable about it now. I have been doing this about three years, but only the last 9 months in high risk--and that as per diem with some shifts in postpartum. I learn something new almost every time I go into work. The people I work with have all been there 10 years plus and they take so much in stride that I am new at. Nice to hear others' opinions and practices.

I think you misunderstood my original post. The Davis drug book says NOT to dilute it. I am just a little unsure of how people are pushing 0.25ml (5mg of a 20mg/ml solution) accurately. Especially in an emergency type situation. We only have 20mg/ml vials available and according to the drug book, that is the only way it comes for IV/IM administration.

So, when you give it undiluted, do you use a 1cc syringe? Do you have needleless systems? Do they have 1cc syringes with lure locks? I'm curious about the actual logistics of administration--I understand the reason to give, the dosage and the actions. You are giving it correctly undiluted!

Don't all 1cc syringes have markings for every 0.01ml? We have two types - one luer lock, one not - and both are labeled 0.1, 0.2, 0.3, etc. with ten lines in between each one, so it's very easy to draw up and administer accurate doses

To give accurately over a minute: Say the dose is going to be 0.25ml of undiluted Hydralazine. Draw it up in a 1cc syringe. Look at the syringe and push 0.05ml into the IV line...count to 12...push another 0.05ml...count to 12. If you continue, you will have given 0.05ml 5 times, 12 seconds apart - which is 0.25ml over 1 minute.

We don't dilute hydralazine in the NICU. We also give it IV push, and I've never seen a drastic dip in a baby's BP - even those with arterial lines that are giving us constant arterial blood pressures on the monitor.