question about diluting!!!

your preceptor should be your guide...i would be very concerned of any "rapid" method for calculating meds on infants...you could consult another senior nurse in the dept to compare...good luck:)

hi there! I am a new nurse in the NICU and have just transfered over from the intermediate side to the intensive side and yesterday was my first day without my preceptor. Things are going good so far, except for one thing: I need a quick method to dilute medications such as morphine.

When we calculate a dose of like 0.03ml, obviously it needs to be diluted for "push", My preceptor showed me her method of diluting it which takes a good 5 minutes to figure out, and i would REALLY apprecaite it if anyone could tell me a formula as to how to do it rapidly. I feel really dumb asking this!! :chair: Any help would be greatly appreciated, THANKS!!!

Everytime I had to calculate a dose to dilute. I double-checked with another RN to make sure it was correct and then wrote it down in a notebook. After I had a list of the most common ones I wrote them all up on microsoft word and then put them in a plastic sleeve in my notebook. Good Luck!

P.S. The only dumb question is the one not asked

Our MSO4 comes diluted from pharmacy in a one:one dilution. If you take 10mg MSO4 and dilute it with 9mls of NS you get 1mg/ml. Your unit should have med guidelines available to you.

We have 2mg/ml morphine but I know you are talking about other meds possibly? I know with morphine we typically draw up 0.5ml of dilutant than in the same TB syringe 0.5mg of the morphine. Then we have a 1mg/1ml concentration which is usually fine even for smaller doses.

Seems like they should stock more dilute meds for neonatal administration? Having nurses perform complex calculations frequently is a recipe for mistakes.

But what do I know, I'm just adult MICU nurse.

Our narcs are diluted by the pharmacy and bottles are sent up each evening and placed in a locked cabinet. We get IV morphine in 1mg/ml and 0.1mg/ml dilutions, Ativan in 2mg/ml and 0.1mg/ml dilutions, and oral morphine in a 1mg/ml dilution.

As for the rest of the meds we dilute on a regular basis, our NICU PharmDs have written detailed instructions for dilution and these are in books at each bedside, so everybody on the unit dilutes the meds the exact same way. They use things like the NeoFax and Pediatric Dosage Manual to find the safest ways to dilute the meds - safe as in the dilution itself is easy on the brain (like making most of our antibiotics 100mg/ml) AND safe as in it's dilute enough not to harm fragile neonatal veins but concentrated enough that we're not spending precious fluids on medications instead of TPN.

Thanks for all your help and suggestions, I FINALLY understand the formula. I think i will bring up the option of smaller available concentrations or everyone using the same formula (which is helpful for doble checking) at our next team meeting because i know i am not the first to have problems with this and it has been suggested before but no one has ever thought up a solution.

Thanks again everyone, i really appreciate it.