Okay, Dumb question=Diluting meds

TazziRN, RN · Feb 27, 2007

1. Draw up required amount in a small syringe, then attach a short needle.

2. Draw up 5-8 ml saline in another syringe. Pull plunger down until it hits the 10-ml mark. Remove needle.

3. Place needle of med syringe into needle hole of saline syringe and inject med into saline.

TazziRN, RN · Feb 27, 2007

And 'tain't no such thing as a dumb question!!!

KellNY, RN · Feb 27, 2007

For instance, if you give 12.5 of phenergren, the vial is 1 ml = 25 so you have to pull 1/2 a ml. We use syringes with the sharp tip plastic "needles". If I pull 1.2 cc to be accurate I would have to use either a TB 1 ml or a 3 cc syringe to get the right amt. of phenergren.
I cant accurately pul 1/2 cc in a 10 cc empty syringe and fill it with saline. What do you do??
So far I have had to draw out 1/2 cc in a small syringe and waste it thus having the correct amt. left in the bottle to draw into a larger syringe. Is this the only way??? Help.
Same if I get an order for toradol 15 and all we have is 30 ml vials, etc. I cant imagine if the order is going to be 6.25 of that 25 cc vial.
Signed, Missing it somehow!!!

I'm a little confused....if the order is for toradol 15mg and it comes in a 30mL vial, you'd draw up 0.5mL. You'd draw that up into an empty syringe, and dilute the rest with NS or whatever you're diluting with.

Same with phenergan, though I'm confused as to why you can't accurately draw up 0.5mL into a 10mL syringe.

Also, if you're giving this IV push (as I'm assuming), you're partially diluting it if you inject it into your main line port as opposed to pushing the syringe directly into the catheter. It will be diluted once you inject it into the tubing. So there may not be a need to dilute with the full 10mLs before hand.

Maybe I'm way off base here, due to lack of sleep or misreading/misunderstanding....let me know.

ETA: Tazzi has some good thoughts!

ETA#2- Drawing out and wasting 0.5mL before hand, and using that as a reference, assuming that what's left is 0.5mLs is wrong, and potentially dangerous (depending on what you're giving). We frequently give stadol here, and if I drew up the whole 2mg/1mL dose, I end up with about 1.2-1.3mL. So if I drew out 0.5mL,thinking that left me with exactly 1mg, I would be wrong, because there would be roughly 1.2mg. With stadol not a huge deal. If it were something else though, it could be.

RNsRWe, ASN, RN · Feb 27, 2007

Same with phenergan, though I'm confused as to why you can't accurately draw up 0.5mL into a 10mL syringe.

Probably because the 10mL syringe is marked off in even increments: 0.2, 0.4, 0.6. She'd be drawing it up and then wasting to an invisible line between the 0.4 and 0.6 marks, and I think she was looking for a way to be as precise as possible.

Recommendations for phenergan IVP are 10-20 mLs of diluent, with the high side being safer, but I read in the latest Nursing2007 that only a fraction of nurses do that correctly, and most use IVs in the hand when that's not indicated either. Still waiting to hear our hospital's word on that one, since so many of our IVs are IN hands (or wherever the heck they can get placed).

Altra, BSN, RN · Feb 27, 2007

For instance, if you give 12.5 of phenergren, the vial is 1 ml = 25 so you have to pull 1/2 a ml. We use syringes with the sharp tip plastic "needles". If I pull 1.2 cc to be accurate I would have to use either a TB 1 ml or a 3 cc syringe to get the right amt. of phenergren. Then I need to add 10 cc of saline. I cant transfer the drug to a larger syringe without loosing some. I cant start with a 10 cc saline filled syringe and squirt out 1/2 cc of saline accurately and fill it accurately with the phenergren. I cant accurately pul 1/2 cc in a 10 cc empty syringe and fill it with saline. What do you do??
If the whole amt (25CC or whatever) of the vial is to be used then of course there is no problem, I load the vial in an empty syringe and then draw up the saline to dilute it.
So far I have had to draw out 1/2 cc in a small syringe and waste it thus having the correct amt. left in the bottle to draw into a larger syringe. Is this the only way??? Help.
Same if I get an order for toradol 15 and all we have is 30 ml vials, etc. I cant imagine if the order is going to be 6.25 of that 25 cc vial.
Signed, Missing it somehow!!!

Think first about what you're giving and how much you'll need to dilute it. This determines the size syringe you need. (i.e., if you want to dilute Phenergan in 10mL of NSS then you need a 10mL syringe. Take 10mL syringe, draw up 0.5mL Phenergan (if ordered 12.5mg). Then draw 10mL NSS into the same syringe. You're ready to go w/your diluted 12.5mg Phenergan in 10mL NSS)

Same principle w/Toradol. If your vials are the same as ours, it's 30mg/1mL. If you need 30mg, draw up the whole 1mL. If you only need 15mg, just draw up 0.5mL. Dilute as needed.

Am I missing what you're asking? Just draw up what you need based on the drug concentration on the vial. If it's 25mg = 1mL, draw up what you need for the ordered dose. It doesn't really matter what the total volume is in the vial.

morte, LPN, LVN · Feb 27, 2007

if you have 10 ml vials of diluent...draw out of it the volume of diluent equal to the volume of the dose of med that you wish to dilute....then draw up the med and inject into the bottle of diluent, withdraw the total in the diluent vial in a suitable sized syringe.......DO NOT STOP IN THE MIDDLE AND LEAVE THE VIAL UNATTENDED....good luck

tridil2000, MSN, RN · Feb 27, 2007

if you have 10 ml vials of diluent...draw out of it the volume of diluent equal to the volume of the dose of med that you wish to dilute....then draw up the med and inject into the bottle of diluent, withdraw the total in the diluent vial in a suitable sized syringe.......DO NOT STOP IN THE MIDDLE AND LEAVE THE VIAL UNATTENDED....good luck

we inject the 12.5mg into a 50ml ivpb bag and drip it over 10 minutes.

Fairlythere, ASN, RN · Feb 28, 2007

Think first about what you're giving and how much you'll need to dilute it. This determines the size syringe you need. (i.e., if you want to dilute Phenergan in 10mL of NSS then you need a 10mL syringe. Take 10mL syringe, draw up 0.5mL Phenergan (if ordered 12.5mg). Then draw 10mL NSS into the same syringe. You're ready to go w/your diluted 12.5mg Phenergan in 10mL NSS

I know how much I NEED, problem is I cannot accurately measure .5 of a 1 cc vial in a 10 cc syringe, as another poster pointed out, the measurements are in increments of 2, 4, 6, etc. Could do 1 cc because there is a mark.

Anyway, I like Tazzi's suggestion, I forget about using a sharps needle to inject into a larger syringe hole. Always using those plastic things, you forget about sharps LOL.

Fairlythere, ASN, RN · Feb 28, 2007

I agree that if there is an iv running and the drug is compatable it may not have to be diluted, but we are supposed to always dilute toradol and phenergren. My problem is not that I cant figure out how much to draw, its that if I want to dilute with 10ccs and the dose is .5, I cannot accurately measure .5 with a 10 cc syringe, they dont have markings that small. My problem was how to get the .5 I draw up in a small syringe into a 10 cc syringe. Tazzi's solution works perfectly for me.

Oh, by the way, I like the idea of hanging phenergren as a drip in saline rather than diluting it and injecting it IVP, it zonks pts out and is so torturous to the vein. Im sure its going to end up being outdated as far as iv use just like vistaril is now.

RoxanRN · Feb 28, 2007

You keep talking about 10ml syringes.... Do you have 3ml syringes? They are marked in 0.1ml increments. I draw up the required amount in the smaller syringe and inject it into a larger NS filled syringe as described by TazziRN.

Roseyposey · Feb 28, 2007

You keep talking about 10ml syringes.... Do you have 3ml syringes? They are marked in 0.1ml increments. I draw up the required amount in the smaller syringe and inject it into a larger NS filled syringe as described by TazziRN.

:yeahthat: That's exactly how I do it. Draw it up in a smaller syringe, waste some of the saline in the 10 cc syringe, change the needle on the phenergan and inject it through the hole in the saline syringe - Voila.