IV Push Med Question

[guest1122560]

Hello there, I am wondering if it is acceptable to draw up an IV push medication that is to be diluted in normal saline with a pre-filled normal saline flush? Or should I pull the normal saline from a single use vial of normal saline? I have seen in practice people using IV flush syringes to draw up IV push meds. I'm just wondering what is the best practice? Does anybody have any evidence base articles about it?

[Leader25, ASN, BSN, RN]

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 .

[lmichelle25, BSN, RN]

I really appreciate the articles every one has posted. I rarely dilute meds in practice but there are other nurses who do and, of course, students come in and want to dilute everything. But now I can be 100% certain that it's basically useless to dilute pain meds or something that doesn't specifically state to dilute it. 

[londonflo]

On 4/11/2021 at 12:18 PM, JKL33 said:

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

The manufacturer of the flush syringe also do not recommend using it to dilute meds.

[londonflo]

On 4/15/2021 at 8:03 PM, lmichelle25 said:

My school taught us to draw up the med and then squirt out a mL or whatever from the flush

Wouldn't this decrease the amount of medication delivered?

On 4/14/2021 at 2:29 PM, NurseShamshey said:

. And in nursing school I was taught to dilute in a flush.

There is a great IV book by Gahardt that explains what needs to be diluted with what and why. I have had students who want to dilute everything and want to give everything over 1-2 minutes.. I show them that there are many medications that do not need dilution (I also remind them to READ the book before coming to me re dilution and push time.)I worked with an instructor who told the students to give everything over 5 minutes. I tried to reflect that the instructor time for 5 students giving IVP meds ends up to be almost an hour (25 minutes just standing there and the time to obtain med, draw up, get to room etc.)

[JKL33]

24 minutes ago, londonflo said:

The manufacturer of the flush syringe also do not recommend using it to dilute meds.

Yes. I wouldn't expect them to since that is not the kind of approval they sought for their product; I assume that a lot more would've been involved in the process required to market it for that purpose. So they couldn't be expected to say that it can be used for anything other than flushing something.

Just the same, it is still normal saline that is approved to be injected intravascularly into the human body. So I wish the safety issue of labeling syringes would be the main focus of the warnings instead of things that are a little far-fetched like saying it's unsafe because the nurse doesn't now how it will react with xyz medication.

15 minutes ago, londonflo said:

Wouldn't this decrease the amount of medication delivered?

How so? Not sure, but I assume they are talking about something like this:

Take vial of 50 mg/1 ml benadryl, draw it up. If there is overfill make sure to just draw up the 1 ml. Take 10 ml saline syringe, expel 1 ml, leaving 9 ml. Place the 1 ml benadryl into the 9 ml. Now 50 mg benadryl/10 ml saline. Or, take the saline syringe, expel 1 ml. Using saline syringe w/ vial access needle, draw exactly 1 ml into saline syringe to bring total to 10. Same concentration results: 50 mg benadryl in 10ml saline.

I am not saying this process is necessary, but I also don't think it needs to be talked about as if rogue nurses have gone off the rails to come up with it. [I know you didn't talk about it that way but I have heard other conversations where it is condemned with significant vigor ? ]. IMO if everyone labeled everything and adhered to aseptic principles it would pretty much be okay.

[JKL33]

I acknowledge that I have defended the process in the past because it is what I was taught and what I am comfortable with and probably for those reasons it makes sense to me. I know these aren't good reasons. So, like I said, I have become more judicious with diluting things.