IV Push Med Question

What are your concerns about using a flush syringe? Try to think about what you need to accomplish when diluting IV meds and whether flushes or single use vials affect the outcome.

As for articles, you could try researching with your school's library resources.

I just want to make sure I'm following best practice. I have watched a lot of videos on diluting IV push meds and they draw from a vial of NS. In clinical I've seen nurses use the flushes. 

The ISMP has condemned the practice of diluting medications in a saline flush syringe, for various reasons.

You can read about it here and other places.

Among the reasons are safety concerns (particularly that of not correctly re-labeling the syringe after medication has been added to it) and then the technical matter that the prefilled saline syringes are FDA approved as devices for a particular use. I personally believe that some of ISMP's arguments against this are weak, but my opinion is not exactly relevant to your question. ?

4 hours ago, Pixie.RN said:

I feel like the infamous vec that should have been Versed was drawn up in an unlabeled flush syringe, if I recall correctly.

I think you're right.

Trying to recall...I'm about 99.99% sure I have never failed to relabel a syringe. Even the thought of it makes me uncomfortable. Actually I used to tape the empty vial to the syringe, and if I'd only used a portion of the med from the vial I'd write the amount on the "tape-tab" I fashioned while wrapping the tape. ???‍♀️. But more recently I have made an effort to be more judicious about what I dilute to begin with.

I do agree with their concern about syringes being unlabeled/not labeled properly. Even in the ED there's almost never a need to go so fast that there isn't time to throw some kind of label onto a syringe that isn't going to be immediately pushed.

It's some of their other warnings that seem like they're meant to shore up their position...I tend to feel that the labeling issue can stand on it's own rather than trying to make a case that dilution itself is generally an unsafe practice.

I use saline flushes to reconstitute when I know I will use the whole syringe, such as with protonix and IVP antibiotics.

With dilution, I would typically just use a new syringe and draw up from a vial because it’s typically small volumes I’m diluting and the flush syringe is too big for me to be accurate. 

As a side note, I also wrap my empty vials around my syringes in the case of intubation, conscious sedation, etc, any time I won’t use it all or right away, or if I’m handing the syringe to another nurse for use. 

I used to do this all the time when I worked on the ambulance (most people didn't even dilute stuff, they just pushed it). And in nursing school I was taught to dilute in a flush. Once I started my job, I was told it's against our policy to do that. I haven't done it since and use a vial. If that's what my hospital wants, that's what I'll do. But it's not wrong to dilute in a flush. The only reason it's looked down on is because people don't label it so you can't "prove" what's in it. Well personally, if I know I'm going directly to a room and won't run into anyone else, I won't label my 1 syringe of benadryl or toradol at 3 am either! (Bad habits. I know!)

My school taught us to draw up the med and then squirt out a mL or whatever from the flush and then stick the needle with the med in the flush to dilute. I see people do this at my hospital also, but I would ask the instructor so you 100% know what they want you to do. 

If you work in an area where you must be super 100% accurate in 0.01-0.1 doses, you must not use ready mix saline,there is the slight chance  of the draw causing inaccuracy.Pull up med,uncap, then use a new syringe draw up saline and pour  newly measured saline into med syringe .