Mixing drips, question pls...?

Jolie, BSN · Jun 23, 2004

Good morning, NICU nurses! I have a question for you...
I currently work in a NICU where the pharmacy prepares all of our meds, all IV's, TPN, IL, drips, etc. I am looking at a job where, I have been told, the nurse mixes all the drips, meds, etc. I am wondering if you have standard concentrations for dopamine and dobutamine drips? For example...how much dopamine do you mix in to your bag? What is the final concentration?
I just want to be prepared....if this comes up when talking to the nurse mgr.
Thanks for your help!

Except in the case of a dire, unforseen emergency, I firmly believe that all meds, drips and emergency drugs should be prepared and dispensed by pharmacy, not nursing. We are not trained pharmacists and already have enough liability without adding that of preparing meds, especially those which require complex calculations. I would want to know why this unit still adheres to a very old practice of requiring nurses to prepare meds when undoubtedly there are pharmacists available. It might be a red flag that other aspects of unit management are not current, either.

That said, if this is the unit practice, then there should be policies and procedures which standardize medication preparation and administration. In one unit where I worked, pharmacy prepared a weekly med sheet based on current weight which was taped at each infant's bedside (HIPAA, I know!) listing the baby's dose of each code drug and instructions for preparing common drips.

I'd definitely raise the issue at an interview and inquire about medication policies and procedures, training for new nurses, etc.

Gompers, BSN, RN · Jun 23, 2004

Where I work, the pharmacy prepares all IVs and drips, always. But we mix up many of our own meds, especially antibiotics. For these, we made a book for each bedside that lists all the antibiotics we use. There are instructions on standard dilutions (mixing to a final concentration acceptable by the neofax or peds dosing manual), compatibilities, running times, etc. So when we double check our meds with someone, we tell them how we diluted it and 99% of the time it's in our book so everyone is on the same page, and the resulting med is dilute enough for a neonate. It kills me that we draw them up sometimes, though, because we have to toss out the vials afterwards and we waste SO MUCH medication that way!!! We'll take like 50mg out of a 1gm vial and that's it. If it were made in pharmacy under the hood and then refridgerated, many of them would last a week down there and they could just draw us up each dose. But nooooo, we apparently like to waste all those expensive antibiotics...and then hear all about shortages. Wonder why!

As for drips, I can imagine that in an emergency we'd have to draw them up, but this is only when we're on transport. We use that rule of 6's, which I hate. But basically, if you want single concentrated dop/dob, all you do is 60mg times the baby's weight, add that to a 100cc bag of 0.9NS or D5W, and then 1cc=10mcg/kg/min. If you want double concentrated it's 120mg times the weight. (We don't do triple or quadrouple, personally.) Insulin, I have no idea how to mix, was never taught.

I do agree, that for drips and IV bags, it's safest for pharmacy to do it.

BittyBabyGrower, MSN, RN · Jun 24, 2004

Our pharmacy does all of ours now. We have a satellite right on our floor for days and eves which is very nice.

When we mix gtts we use the rules of 6's...we have floor stock to mix if we need the drip like yesterday. So, take the weight x6x10 and that is what you add to a total of 100mls of fluid. Doubled we just add to 50mls total fluid.

Jolie...many hospitals don't have peds pharmacists and that is usually the reason that they have the floors make them. We just started having pharmacy make our meds in the past 2 years. We had a giant manual that we used. When we don't have a peds pharmacist on, it takes like twice the time to get our drips and such because the other pharmacists are running for the ICU's and ER. Ugh.

nicubabe · Jun 25, 2004

The NICU that I work in has always mixed our own meds and drips until recently. We don't have a pediatric pharmacist and are very leary of the meds etc. that we now get from the pharmacy so we are constantly double checking and frequently find errors. It's beginning to get better with fewer errors,but old habits die hard sometimes.

gypsyatheart · Jul 2, 2004

Thanks for the replies. The hospital I currently work at has its own satellite pharmacy so we do very little med mixing, except abx. I am considering interviewing for a facility that stated NICU nurses should be competent in mixing drips, etc. So, we'll see...

Thanks again!

gypsyatheart · Jul 2, 2004

Thanks for the replies. The hospital I currently work at has its own satellite pharmacy so we do very little med mixing, except abx. I am considering interviewing for a facility that stated NICU nurses should be competent in mixing drips, etc. So, we'll see...

Thanks again!