Diluting IV meds

kiszi, RN · Jun 17, 2015

If mixed well and measured correctly, why wouldn't the doses be accurate?

That said, saving a narcotic syringe to give a second dose later is considered a big no-no, and nurses at my hospital have been written up for it. We are supposed to give the dose and have someone witness the remainder being wasted every time.

I don't dilute IVP meds generally unless the drug is required to be diluted. But I just re-read your post. I think the highest concentration our morphine comes in is 4mg/ml. 10mg/ml I might consider diluting too. At any rate, agitate the syringe well after mixing and the concentration should be uniform.

wanderlustnurse88, RN · Jun 18, 2015

We use the smallest dosage available which is 10mg/ml. We are suppose to waste at the end of the shift.

Here.I.Stand, BSN, RN · Jun 21, 2015

I was told by a previous manager that the DEA disagrees. It used to be our routine to give multiple doses from one carpuject, but one day she instructed all of us to stop immediately. "This is a DEA thing. Don't worry about being wasteful, yes I know it's a pain to find a witness every time. You just have to do it." I imagine it would be nearly impossible to account for every single dose if a syringe with an unverifiable (if diluted by the RN) amount of drug was sitting in a drawer (pocket???)

akomismo · Jun 21, 2015

You cannot say its exact amount you give when you dilute the meds and its not a safe practice to store remaining dose it should be waste per hospital protocol (US hospital using bar code scanning) Better not to dilute to provide exact amount of medication. Right dose :)

Btw r using bar code scanning for medications?

psu_213, BSN, RN · Jun 21, 2015

We are suppose to waste at the end of the shift.

According to who? This sounds like big trouble.

At the end of a shift, suppose someone comes up to you and says "I pulled up this morphine at 9 this morning. I saved some of it, but at some point the plunger of the syringe was pushed down and the med was lost. Now I need you to waste it with me?" You trust the person, so you waste with them, even though you don't actually witness the waste. That person was diverting and now you are an accomplice.

Instead, say it was you carrying around the morphine. It somehow got squirted out. Now no one will waste with you. It looks like you pulled out 10 mg of morphine, gave 2 mg and now have 8 mg that are not accounted for. That could be big trouble too.

To answer the original question, yes I dilute IVP narcs. But I also waste the unused portion right away.

BecomingNursey · Jun 21, 2015

You can't be 100% sure that your dosage is correct when you mix it and give it like that. The proper way to do it is draw up what you need and mix it with NS (if compatible) and waste the rest of the medicine right away and have someone lay eyes on you actually wasting the medicine.

You worked hard for your license. It's only right for you to do things the correct way to protect it.

calivianya, BSN, RN · Jun 28, 2015

I only dilute vesicants. I never dilute controlled substances unless I have to - like with Ativan, since it's such a horrible vesicant, or if I have to give a really small dose like 0.25 ml of undiluted solution and I'm sure I won't get it right without mixing. If I do have to dilute and waste some of it, I invert the syringe multiple times after I draw it up. Whether or not it evenly mixes the med, it makes me feel like it's probably more evenly mixed.

Gray Fox · Jun 29, 2015

Great feedback to Flutist! Mixing IV push meds is a practice that deserves a serious second look. Let's just talk about narcotics. First of all, they should be provided to you in the most ready to administer form available. Your pharmacy should be making a range of concentrations available to you. Secondly, diluting and saving the syringe for future doses does not meet requirements for medication storage and security. As previously noted, who could witness the waste with integrity? Third, syringe to syringe transfer (using Carpujects) is a contamination risk. Fourth, narcotics do not need dilution for administration - they are not vessicants. If you are diluting to control the rate of administration, consider this: the rate of administration if better controlled by the rate of the a)running IV, or b)rate of flush following injection.

wanderlustnurse88, RN · Jun 29, 2015

Yes thanks everyone for the great feedback. I will bring this up with my manager to review best practices. Unfortunately this was the way I was taught and it's how the nurses here are doing it (bad excuse for continuing the practice). We are a small rural hospital and our pharmacy is off site so we often just have the dosages available in larger amounts.

JustKeepSmiling, ADN, BSN, RN · Jun 29, 2015

That could happen. Same thing with giving half a pill.

When I was induced they used cytotec to ripen, the L&D nurse warned me that since it was a piece of a pill I may or may not get the entire dose because of that.

dudette10, MSN, RN · Jun 30, 2015

Fourth, narcotics do not need dilution for administration - they are not vessicants.

I always go with the drug guide. Davis' Drug Guide for morphine states:

[h=2]IV Administration
[/h]
IV: Solution is colorless; do not administer discolored solution.
Direct IV: Diluent: Dilute with at least 5 mL of sterile water or 0.9% NaCl for injection. Concentration: 0.5â€“5 mg/mL.

Davis's Drug Guide | morphine