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Discussion

IM Ativan

Hi guys,

I just started working at an inpatient psych facility and naturally have had to give IM Ativan several times now. Since the medication is so viscous I want to know how it is appropriate to dilute it. Looking in several different drug reference guides there is no clear and concise answer on if/how this should be done and talking to other nurses that I work with everyone seems to do it their own way.

Anyways what are your guys' suggestions? Thanks!

Oh yeah, also what gauge needle too?!

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    I've worked inpatient psych and given IM ativan many, many times. Never diluted it before, but I'm curious if others have.

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    • Experts

    We give it IM quite frequently where I work and we don't dilute it.

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    It's syringe compatible with Haldol so if you're giving both it thins it out a bit. I've never diluted it otherwise. It burns less if you push it slower also if the muscle is relaxed. I often encourage pts to "wiggle your toes" as I'm pushing as this tends to have them relax their gluteal. Also advising them to move the muscle afterwards to reduce pain, flex the knee or elbow a couple of times.

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    • Experts
    It's syringe compatible with Haldol so if you're giving both it thins it out a bit. I've never diluted it otherwise. It burns less if you push it slower also if the muscle is relaxed. I often encourage pts to "wiggle your toes" as I'm pushing as this tends to have them relax their gluteal. Also advising them to move the muscle afterwards to reduce pain, flex the knee or elbow a couple of times.

    Actually we are usually giving it with Haldol as well so I guess it does thin it out like you said. When we give it the person is usally being held down by three or four other staff at the time so we aren't taking the time to tell them to wiggle their toes.:laugh:

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    they are for me too and you would be surprised how much it helps them to feel like they can have control over something and in the moment it may only be wiggling their toes. it's something i picked up when i worked peds and it works well with adults too to assist them with distraction.

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    • Experts
    they are for me too and you would be surprised how much it helps them to feel like they can have control over something and in the moment it may only be wiggling their toes. it's something i picked up when i worked peds and it works well with adults too to assist them with distraction.

    Ours are in no state to listen to you telling them to wiggle their toes. Ours are too busy trying to get in a punch.lol

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    If I'm not giving it with Haldol, I mix in a mL of sterile saline.

    Another thing I do if I'm giving it because patient wants it, is hold needle in them 10-20 seconds after I've pushed to let them more of it.

    Z Track or not, I get it running back out.

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    • Experts

    A LVN taught me this trick: draw up your Haldol, inject it into the Ativan bottle, then draw the mix back into the syringe. Makes for an easy draw.

    Of course, if you're using less than 2mg of Ativan, this won't work unless you draw some Ativan out first. But I've rarely seen Haldol/Ativan ordered that wasn't 5/2 or 10/2. Sometimes 5/4 or 10/4 if the patient is built like a linebacker.

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    Our docs prefer Geodon to Haldol IM so we give it in 2 shots if we are giving Ativan too. I have never diluted it. I draw and give in a 20 gauge. I know it sounds mean, but its easier to draw up and quicker to give rather than having a needle sit in a patient while I have to slowly push it in.

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    I'v never seen Ativan diluted...

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    No dilution done at my facility. Our concern in over getting fired or written up for doing a forced med! :-/

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    we do not use dilution when we give it where i work. our docs use geodon a lot too so it is two injections

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