IV Medication Administration

Nursing Students General Students

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I'm a nursing student in my second year of the RN program and I am having such a difficult time with IV reconstitution and it's really discouraging me in this program.

I'm mainly just having a hard time really grasping how to read and know what numbers to pull from the parenteral drug manuals, and I'm not sure how to figure out what size IV fluid bag to then put the reconstituted medication in. I haven't had the opportunity to do many IV meds throughout my clinicals thus far and I don't feel like my school has put much effort into actually teaching us how to read parenteral manuals but instead just put us through medication administration exams which I don't struggle with at all but somehow only struggle when reading the actual manual.

Can anyone help me with this or know of any good videos out there that can help me grasp this concept?

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We really need to know what drugs you are reconstitution. Can you provide some examples.

I have never had a problem with reconstituting, but it has mainly just been plain old commonly used antibiotics.

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We really need to know what drugs you are reconstitution. Can you provide some examples.

I have never had a problem with reconstituting, but it has mainly just been plain old commonly used antibiotics.

Same here. For instance I'm really only most familiar with reconstituting Rocephin in NS of 500mL bag or more to administer IV route.

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Specializes in Critical care.

The only thing I've ever had to reconstitute that wasn't sent from pharmacy in a vial attached to a normal saline bag is IV push Protonix (which is just mixed with 10ml of normal saline). Our pharmacy takes care of pretty much everything and is there 24/7. I've worked in 2 different hospitals, granted both are larger trauma centers.

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Specializes in Pedi.

If it makes you feel better, 90+ % of the IV meds you administer in the real world will be reconstituted in the Pharmacy. In my 5 years as a hospital nurse, the only meds we reconstituted on the floor were IV protonix and IV ampicillin 2g vials. In home infusion I occasionally sent patients home on drugs that needed to be reconstituted at home (tigecycline, unasyn and ceftaroline were the big ones) but those were full vial doses that were attached by the Pharmacy to mini bags of normal saline and all the family had to do was break the seal and squeeze the bag to reconstitute it.

Can you give us an example of a problem you are struggling with?

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Thanks for all the responses everyone! I actually didn't know that there were hospitals/units where the pharmacy actually reconstituted your meds for you! I'm not sure if this mostly happens on highly acute units or maybe this is more common in the US..? I'm studying nursing in Canada and I have yet to see a unit where the nurses aren't the ones reconstituting their own meds! Man would that make life much easier on nurses!

An example would be Piperacillin-tazobactam. I'm not sure why reconstituting this antibiotic always has me so confused!

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also, after having reconstituted the med. how do you determine what size mini bag you use? is there a particular calculation you do to figure that out or is that purely just based on nursing judgement?

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Specializes in Pedi.
Thanks for all the responses everyone! I actually didn't know that there were hospitals/units where the pharmacy actually reconstituted your meds for you! I'm not sure if this mostly happens on highly acute units or maybe this is more common in the US..? I'm studying nursing in Canada and I have yet to see a unit where the nurses aren't the ones reconstituting their own meds! Man would that make life much easier on nurses!

An example would be Piperacillin-tazobactam. I'm not sure why reconstituting this antibiotic always has me so confused!

I have literally never reconstituted Zosyn in any of my jobs. It's always been mixed in the pharmacy.

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Specializes in Pedi.
also, after having reconstituted the med. how do you determine what size mini bag you use? is there a particular calculation you do to figure that out or is that purely just based on nursing judgement?

Assuming you have to recon on the floor, there should still be a formulary with instructions that tell you how much to recon with.

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You said you don't have much experience doing IV meds in clinicals so far. Do you pick your own patients? If so, try picking pts by looking to see which ones have IV meds that you will be able to give. If you don't, speak to your clinical instructor and ask if he/she can give you pts with more IV meds so you can learn.

When I was in nursing school, we picked our own pts. I chose my pts based on what I needed to work on. If there was a condition I needed to learn more about, if we were learning about a disease/condition in class that I wanted to know more on or wasn't really grasping, or when I needed med admin practice. I chose my pts based on what I needed. When we first learned IV meds, I first looked for pts that had some disease/condition we were learning about in class, then from those I found which had the most IV meds that I could get practice with.

The best way to learn is by doing it, so try to get as much practice as you can with it!

As for reconstitution. In the U.S, we have Lexicomp. So, before giving my pts meds, I would research each of them using Lexicomp (in the pts MAR, you click on the med, and can get to Lexicomp). Then, you can find the reconstitution instructions there. Do you have something like that in Canada?

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I'm a student in Quebec in my Internship. 90% of the time the meds come already reconstituted at my hospital, even pipercillin-tazobactum comes prepared in a syringe ready for the syringe driver.. The only medication I've ever had to reconstitute is Pantoprazole, and at my institute the pharmacy includes specifications on how to reconstitute the med on the MAR. I woulden't worry about it though i'm assuming wherever you work you will see a lot of the same things and if not you can always call pharmacy for their recommendations or check a med book or digital med book.

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A average, decent IV drug book for nurses will always say how much, what volume, of IV fluid to mix the reconstituted drug in.

Invest in a good IV book designed for quick look up for nurses.

We always had several such books around. And made a carefully tripple checked list of the odd IV meds that needed more that the usual 50 or 100 ml bag.

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