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intravenous diazepam

rjrule rjrule (New) New

Specializes in Emergency/Paediatric.

Recent articles have documented that intravenous diazepam should not be given diluted. However, we recently had a very aggressive psychiatric pt and the senior ER m.o instructed me to draw the 10mg ampoule to 10ml normal saline then give the medication into the iv cannula. I have had some nurses say yes and some say no re this procedure. I have always thought the medication will precipitate. Does anyone have the latest theory re this problem?:uhoh3:

Mommy&RN, BSN, RN

Specializes in Med/Surg & Hospice & Dialysis. Has 6 years experience.

It is recommended to inject diazepam directly into a large vein at a max rate of 5mg/min. If it is given as an infusion, the fluids are to be added to the diazepam, and not the other way around. There is still a risk of precipitation.

Zookeeper3

Specializes in ICU, ER, EP,. Has 17 years experience.

Perhaps his fear was that if not diluted, it's only in 2ml's, then you give a flush after and it is potentially administered too quickly?

In hurry up situations, he may have come across nurses who push the flush super fast? Don't know... but it doesn't play well when mixed with other fluids :) Not exactly answering your question, but looking as to WHY he specified this... it's not often I have a doc tell me HOW to push any med... they are the experts at ordering, I'm the expert at administering it.

It sounds like he wanted you to give it fast and that was one way of diluting the concentration so you could just push it in without being concerned that too much would go in too fast. In this situation, I would have done it that way if he had specifically requested. I would think that it wouldn't be sitting in the syringe long enough for any precipitates to form.

nursynurseRN

Specializes in TELEMETRY. Has 12 years experience.

Recent articles have documented that intravenous diazepam should not be given diluted. However, we recently had a very aggressive psychiatric pt and the senior ER m.o instructed me to draw the 10mg ampoule to 10ml normal saline then give the medication into the iv cannula. I have had some nurses say yes and some say no re this procedure. I have always thought the medication will precipitate. Does anyone have the latest theory re this problem?:uhoh3:

Just last week I was going to give and dilute it when I did it turned white!!! so i spoke to pharmacy and they told me that it is not be diluted and it should be given direclty to the closest port to the vein.

ZippyGBR, BSN, RN

Specializes in Spinal Cord injuries, Emergency+EMS.

emulsion or the oily IM only stuff ?

the policy ofthe trust i work for and of others in the locality aswell as the JRCALC paramedic guidelines is that only Daizempan emulsion should be given IV ....

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

Our references say it's OK diluted like that for 4 hours.

related to my experience, IV Valium have to be diluted only by blood, that means, we have to take some blood as back flow (5 ml) and than inject IV, like that to avoid all kind of reactions with NS or others IV solutions.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

While Diazepam forms a precipitate in pretty much any IV fluid, it doesn't actually matter, the precipitated diazepam can be injected without any safety or efficacy issues so long as it is injected reasonably slowly. This is because the precipitate immediately re-suspends when introduced to blood:

However, the precipitate which was formed became completely resuspended when mixed with as little as 39-42% plasma in vitro. This would indicate that the chalky precipitate seen in the I. V. tubing when Valium is injected into a running I. V. near the venipuncture site becomes resuspended when mixed with plasma in vivo. If one elects to inject Valium into the tubing of a running I. V., it is recommended that the drug be administered slowly to assure adequate mixing with blood plasma in order to prevent the circulation of particulate matter.

Solubility of Injectable Valium in Intravenous Solutions

Ativan way less trouble than valium

That's right. Diazepam is not diluted in NS. It is given slowly IVP by itself. Then flush.

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