IV narcotics?

[AlphaPig]

Ok, I know this is a stupid/basic question, but I just would like advice. We used to have the nice vials of narcotis with the measure on the side so you could see how much you pull up (like, if patient is to get 2mg and it is a 4 mg vial, you could see on the side that you pull of .5 ml) but now we just have these vials with no measurements. I used to pull up the meds into a 10cc pre-filled flush syringe, but now I can't get an accurate measure of pain medication doing this. We don't have little vials of NS, so I can't pull up the med into an empty 10cc syringe and then pull up NS.

Anyway, how do you guys pull of narcotics and ensure you are giving the correct dose - it's especially hard with the patients who only get .5 Dilaudid (which is only .25ml!)

thanks.

[FLArn]

I pull up the med into a 3 cc syringe to measure (a TB syringe for really tiny amounts) and inject the med into the pre-filled 10 cc flush to dilute.

[sapphire18]

Agree with the above. How did you waste if you only pulled out half of the drug? I know I used to leave it in the vial and then throw it in the sharps, but that is not correct practice...correct practice is to waste into the sink (which I don't agree with), trash, or toilet.

[liveyourlife747]

I agree with above posters. Pull up in a 3ml syringe with a needle (or filter needle then switch to another needle) and squirt out however many mls of NS you need to be able to have room inject the medication into the syringe. Pull back the plunger to allow air in the NS and inject the med in.

Hope that's understandable.

[Perpetual Student]

I would do it as above posters described in the situation at hand. Another way to do it is to draw up some NS from the flush into another 10 cc syringe, then draw up the appropriate amount of drug. That would be the correct way if you needed a precise concentration of drug in your syringe, for instance if you were going to titrate a medication to effect.

Also, if the patient has a running IV I will open it wide open and just use a 3 cc syringe for the drug, drawing back from the bag to dilute it. That's a little more cost effective (and less work), plus when you're done you can just pull back again and push it in to flush it.

[turnforthenurse, MSN, NP]

I draw up the med using a 1cc syringe then inject the amount into a prefilled 10cc NS flush.

[iluvivt, BSN, RN]

You need to ask for the NS in a vial to be used as your diluent. Pre filled NS in a syringe SHOULD only be used for catheter flushing per the IFUs of all the manufacturers of these products There has been an ISMP warning put out to healthcare workers that this is not a safe practice, You need to point this out to your employer, This may also help http://www.ismp.org/newsletters/nursing/issues/NurseAdviseERR201209.pdf

[Jory, MSN, APRN, CNM]

I pull up the med into a 3 cc syringe to measure (a TB syringe for really tiny amounts) and inject the med into the pre-filled 10 cc flush to dilute.

This is how we were taught to do it in accordance with hospital policy. If you do it the way the OP is, you risk some of the saline getting flushed back into the vial and not giving the appropriate dose...marked or not.

[PedRN86]

I draw the med out of the ampoule/vial with a 1-3cc syringe and then transfer it to a pre-drawn 10cc NaCl syringe

[PediLove2147, BSN, RN]

I do it the same way as all the posters here. I sometimes feel weird squirting the drug into a 10cc syringe but it works. No other way to make sure you have an accurate amount.

[classicdame, MSN, EdD]

someone in materials management needs to order you the right sort of syringes, etc. They do not always think of your special needs so let someone know. Risk mgt will thank you

[psu_213, BSN, RN]

I pull up the med into a 3 cc syringe to measure (a TB syringe for really tiny amounts) and inject the med into the pre-filled 10 cc flush to dilute.

In our hospital, we once again have no 1 mg/mL dilaudid d/t a 'national' shortage. We only have the 2 mg/mL strength. The biggest issue is when doctors order 0.2 mg...that is 0.1 mL of the med. Pretty much impossible to draw up even with a 3 mL syringe...a TB syringe has to be used. I draw up with the TB syringe and inject it into a 10 mL flush.