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IV Valium and precipitates...

Posted

Specializes in MICU for 4 years, now PICU for 3 years!. Has 7 years experience.

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

Specializes in Neonatal ICU. Has 5 years experience.

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

Specializes in Critical Care.

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

Specializes in Critical Care, Emergency, Education, Informatics. Has 40 years experience.

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

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

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.

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

leslie

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

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

Specializes in Critical Care.

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.

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.

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

Has 4 years experience.

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 :no:. I've never given diazepam IV push.

tri-rn

Specializes in MICU/SICU.

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

Nursetastic

Has 4 years experience.

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

Great, actually. It may take 3 of us to turn the patient and get it administered but once it is given it works great. Nice, long half life and even with the most severe withdrawals it is a great adjunct to Ativan.

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