Medication preparations for real

Vana21, ADN, BSN, RN · Mar 1, 2016

I'm not sure if im answering correctly based on your situation but it sounds like you might be referring to an IV push?

So for example, if you have 1 mg of morphine ordered and the vial is 1mg/ml. What I do is take a flush thats 10 ml, squirt out however much I need to draw into it (so for this i would take 1 ml out), put a needle on it and draw up the 1 ml of morphine. That way its diluted.

If the bottle comes with 3 inside of it, I will only draw up the 1 ml. This specifically because if you have a med you need to witness a waste, the"correct" way to do it is to draw up the remaining 2ml and show it and then waste it. I know not everyone does this, but it can be odd when you're supposed to waste 2ml and someone tosses an empty container.

Lev, MSN, RN, NP · Mar 2, 2016

As a nursing student I have observed nurses making up the same drug in several different ways, and was wondering what is the best way to make up medications such as the following;
Fentanyl IV 25mcg (comes as Fentanyl 100mcg/2ml). Some draw the medication up the whole amout from the vial and then discard what isn't needed and then add saline, others draw it all up and then discard out what they don't need, which is the one that confuses me a little, not quite knowing the amount to draw up and how to work out what to discard.

The saline is being added to control the rate that the medication is pushed IV. This is to make sure that you don't push too fast and for certain medications to help the patient avoid the high and/or discomfort when the medication is given to quickly. As far as drawing up the medication, everyone has a way they are used to. No way is better than the other. For controlled medications, they extra medication must be wasted so technically another nurse should see that there is some left over.

nutella, MSN, RN · Mar 2, 2016

As a nursing student I have observed nurses making up the same drug in several different ways, and was wondering what is the best way to make up medications such as the following;
Fentanyl IV 25mcg (comes as Fentanyl 100mcg/2ml). Some draw the medication up the whole amout from the vial and then discard what isn't needed and then add saline, others draw it all up and then discard out what they don't need, which is the one that confuses me a little, not quite knowing the amount to draw up and how to work out what to discard.

Think about safety.

If you draw up he whole 100mcg of Fentanyl with NS towards lets say total volume of 10 ml you would have 100 mcg of Fentanyl in 10 ml. Let's say your best intention is to waste the not ordered 75 mcg but you get distracted, forget or such and by accident administer the whole 100 mcg ....

In my opinion it is always best to draw up only the mount ordered and waste the rest right away. You can dilute the needed amount with whatever is compatible (some meds require actually sterile water..), some you do not need to dilute, others you should. It also makes a difference if it is peripheral or central line in some cases.

RNperdiem, RN · Mar 2, 2016

Here is how I do it. I get the glass ampoule of 100 mcg of Fentanyl. The order is usually for a dose of 25-50mcgs. I call a coworker over to witness the waste of the unused portion. I take a filter straw, draw up the whole 100mcgs and waste the unused portion in the sink, have my coworker sign the witnessed waste and then I take my empty ampule and correct dose to the patient room. I do not dilute the med in normal saline because in ICU that patients have a running saline infusion.

I wonder why there isn't a smaller dose available. It seems half the Fentanyl we take out goes down the drain.

twozer0, NP · Mar 2, 2016

As a nursing student I have observed nurses making up the same drug in several different ways, and was wondering what is the best way to make up medications such as the following;
Fentanyl IV 25mcg (comes as Fentanyl 100mcg/2ml). Some draw the medication up the whole amout from the vial and then discard what isn't needed and then add saline, others draw it all up and then discard out what they don't need, which is the one that confuses me a little, not quite knowing the amount to draw up and how to work out what to discard.

You dont need to dilute fentanyl at all (i give it everyday, multiple times). We use the same concentration of fentanyl here. 25mcg is 0.5 cc. I never dilute mine, I just give it. Some nurses might dilute if they are giving it to children as the drug then becomes mcg/kg and can get into smaller amounts. I never waste until the patient is beyond my care, I always hold my sticks (I draw up all the medicine in the syringe). Waste with coworker after patient leaves. As the old saying goes, there is no right or wrong way to skin a cat.

Emuhawk000 · Mar 2, 2016

Thanks for the replies everyone. One other thing along the same lines is that when I see morphine mixed up it's simple, say 8mg is ordered, so 10mg is drawn up into 10ml of saline and then 2ml is discarded to give the 8mg. So when an order for Fentanyl 75mcg is ordered, I see 100mcg drawn up into (sometimes 11 or 12 mls of normal saline and the desired amount discarded, and this is where I get a bit confused, because Fentanyl comes in a mix of 2ml, what should the correct amount be to discard?

Vana21, ADN, BSN, RN · Mar 3, 2016

One other thing along the same lines is that when I see morphine mixed up it's simple, say 8mg is ordered, so 10mg is drawn up into 10ml of saline and then 2ml is discarded to give the 8mg.

The thing about doing it this way (correct me if im wrong) is they will have 10 mg diluted in 10 ml. So even though they squirt out 2ml, there is no way of knowing there is 2 mg of medication in that 2 ml. I can see where that thought originates from thinking thasquirting out the 2ml means there would the be 8mg in 8 ml, but personally, I think its risky and wouldn't do it that way.

Do what they taught you in nursing school. Sometimes being on the floor can develop bad habits in some people, and its tempting to develop them yourself.

LadyFree28, BSN, LPN, RN · Mar 3, 2016

Thanks for the replies everyone. One other thing along the same lines is that when I see morphine mixed up it's simple, say 8mg is ordered, so 10mg is drawn up into 10ml of saline and then 2ml is discarded to give the 8mg. So when an order for Fentanyl 75mcg is ordered, I see 100mcg drawn up into (sometimes 11 or 12 mls of normal saline and the desired amount discarded, and this is where I get a bit confused, because Fentanyl comes in a mix of 2ml, what should the correct amount be to discard?

I can only speak about the morphine...

Morphine can burn, so diluting the morphine is not a bad thing.

When I draw up 8mg of morphine, I only draw up the dose required, have someone witness, then dilute it; I never draw up the whole amount of the vial and dilute it first.

My use of Fentanyl is limited at best via a Fentanyl drip in a CC unit; at least in my ED, I haven't used Fentanyl as much, and when it is used, my technique is the same-drawing up only the amount ordered.

The bottom line is to only draw up what the pt needs.

Penelope_Pitstop, BSN, RN · Mar 3, 2016

The bottom line is to only draw up what the pt needs.

This.

As for Fentanyl, we just pushed it in the ICU. We only gave it to our vented folks anyway. On the floor, I diluted everything for the most part.

Remember "Desired"/"Have" times "Vehicle"