Medication 20% Rule.

Never heard of it. Pharmacy does most of our mixing. We will dilute fentanyl and methadone, but my impression was that it was because the amounts can come out to 0.01 or 0.03mL that can be more easily squirted out on accident. Fentanyl comes in vials of 100mcg/2mL and we dilute it to a concentration of 100mcg/10mL (10:1)

I've never heard of it either. Our pharmacy mixes all our Meds except for a select few. We just draw up or are dispensed what we need, put it on the med line or push it in if it is less that the amount to purge our line and give/flush in.

I have only been in the NICU for about 6 weeks, but I haven't heard of it either. The practice I've been taught so far is summed up by what the other two posters have said already. Granted, there is a ton/many situations that I still have not seen yet, I'm very sure.

We do the same as babyRN. I shiver at the thought of some of our nurses mixing meds...

never heard of it either

Only heard of the 50% rule. If a med is missed at say 8 am and is scheduled again at 2pm (say BID) you can give the 8 am dose up until 11 am (6 hours until next dose, so you can give it half the time between the next dose... 3 hours before the next dose is scheduled to be given) my guess is the 20% rule is some form of this

Hi we use the 20% rule in the NICU. We only use it on administration of any narcotic or sedation medication. We draw up 20% of the total amount of the medication and do our medication drug calculations based on this to get the most accurate safe medication doses to give to the pts. For example 100mcg in 1ml the 20% or 0.2ml amt 1st drawn up is 10mcg. If the dose is 2mcg, then we will reconstitute the 0.2ml of Fentanyl with 0.8ml of Sterile water to = 10mcg in 1ml. Then we push out again to 0.2ml which = 2mg of Fentanyl and reconstitute with 0.8ml of Sterile water and then administer to the patient. This process is witnessed by another RN. Hope this helps.

Woah, sounds complicated!

Wow. That does seem complicated and time consuming!

Hi we use the 20% rule in the NICU. We only use it on administration of any narcotic or sedation medication. We draw up 20% of the total amount of the medication and do our medication drug calculations based on this to get the most accurate safe medication doses to give to the pts. For example 100mcg in 1ml the 20% or 0.2ml amt 1st drawn up is 10mcg. If the dose is 2mcg, then we will reconstitute the 0.2ml of Fentanyl with 0.8ml of Sterile water to = 10mcg in 1ml. Then we push out again to 0.2ml which = 2mg of Fentanyl and reconstitute with 0.8ml of Sterile water and then administer to the patient. This process is witnessed by another RN. Hope this helps.

The point is that is our policy, and what our hospital deems as safe administration of narcotics and sedation. Yes time consuming, however it gets fast with addition into your daily practice.

whats the point?

The point is that if you give a narcotic such as Fentanyl too rapidly, one of the side effects is chest wall rigidity. The infant cannot ventilate, and will desat. and brady.

In our unit, we drew up the required dose of narcotic in one syringe.(e.g. 3mcg of Fentanyl=0.03ml of a 100mcg/ml Fentanyl) In a second syringe we drew up 0.3ml of NS. Then we would add the 0.03ml Fentanyl to the 0.3ml NS syringe.

Let's say your microbore tubing usually has a total volume of 0.3ml. So I would push the med. into the tubing, and set the syringe pump to deliver the total dose over 5-10 minutes. That would include med+flush of an additional 0.3ml of NS, or whatever your unit policy was.