IV Valium and precipitates...

[WSU_Ally_RN, BSN, RN]

So I am here at work attempting to give my pt IV Valium, but everytime I go to dilute it down so I have a workable amount to push, it precipitates! I have tried to dilute in NS and sterile water both, and they both cause a precipitate. I'm worried that if I just go ahead and push through the hep lock that it will cause a precipitate in the IV... what to do??? Any tricks of the trade out there to push this?? Thanks! :)

[gibson0726]

Diazepam is not soluble in any solution.

Per my Gahart IV book:

If dilution is imperative, add dilutions solutions to diazepam, not diazepam to solution; consult pharmacist. Direct IV administration is preferred but can be administered at a Y-tube injection site.

Give 5mg (1ml) or fraction thereof over 1 minute.

[hypocaffeinemia, BSN, RN]

Micromedex lists "variable" on valium's compatibility with most solutions, with some manufacturers listing NS as physically compatible and some listing immediate precipitation.

Here's one study:

"A study of the solubility of Valium in commonly used intravenous solutions showed Valium to be equally insoluble in 5% dextrose in normal saline, 5% dextrose in water, normal saline, and Ringer's lactate. 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."

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2516026

[CraigB-RN, MSN, RN]

Diazepam is not soluble in any solution.

Per my Gahart IV book:

If dilution is imperative, add dilutions solutions to diazepam, not diazepam to solution; consult pharmacist. Direct IV administration is preferred but can be administered at a Y-tube injection site.

Give 5mg (1ml) or fraction thereof over 1 minute.

I concure with this. Valium is one of the few drugs that you are not supposed to dilute.

[iluvivt, BSN, RN]

I often used to draw it up and use a 25 gauge 3/4 inch needle and just access a good vein...administer it and then pull the needle out.....you have to be good at venipunture though/ You are right you will probably occlude the line.

[leslie :-D]

it's supposed to be given in a large vein, 5 mg over a minute or even slower.

leslie

[FireStarterRN, BSN, RN]

I don't see valium being given at all in my locality. I can't recall giving it. Thanks for the info, just in case I need to give it.

[hypocaffeinemia, BSN, RN]

I don't see valium being given at all in my locality. I can't recall giving it. Thanks for the info, just in case I need to give it.

I've seen in used instead of ativan for seizure control in our ER, however I don't recall ever seeing IV valium up in our ICU. Our seizure protocols allow for ativan 1 mg as frequent as necessary to establish control so we pretty much run with that.

[Peonysorbet]

Never give Valium IV as you can send the patient into cardiac arrest. Even anestheisologists don't ever give this route in our facility. IM, on the other hand, is a very painful injection to give. Best bet is PO. Hope this helps.

[nurseprnRN, BSN, RN]

dilantin's another one that makes pretty crystals in your iv tubing. don't give it, or run it in a drip, with another iv fluid.

[Nursetastic]

My unit has started using diazepam rectal gel in severe ETOH withdrawal where lorazepam alone is not effective. Nurses love it...patients, not so much . I've never given diazepam IV push.

[tri-rn]

A rectal gel for folks in severe EtOH withdrawal? How's that working out?