When to dilute IV push meds ???

jabiru · Oct 31, 2006

I shudder when I think of that!!
In Australia the containers that hold pottasium are similar to the ones that hold sterile water and normal saline, (10ml), only the colour of the writing is different. I hope this is changed soon.
In Australia we have what we refer to as the 'bible' for IV meds, lists all the info you could possibly need. I use it everytime, no matter what I think I remember.

They used to be on the counter in the drug room, next to the Water for Injection and N/Saline. At least these days they're locked up.

BGgirl · Oct 31, 2006

We have to scan all our meds with a handheld device that we also use to scan the patient. Pharmacy enters notes into them which tells us which meds to dilute with how much saline and how fast to push the meds for certain standard meds. Very convenient.

We've also started diluting phenergan and there is a note the in pocket of our accudose that tells us how much to dilute it with, which port to use and how fast to give it.

rita359 · Oct 31, 2006

I am a new nurse on a med/surg floor. We give a lot of our meds IV push and I'm having a hard time remembering which ones need to be diluted, which ones need to be pushed slow, etc.... Can anyone list some of the common meds that need to be diluted or pushed slow? I feel so lost trying to remember all these meds on top of trying to learn the new job. Does it ever get any better??

Somewhere, in your hospital IV therapy policy you should be able to copy a list of such IV meds plus meds that cannot be given on medsurg units and can only be given to monitored patients.

GeminiTwinRN, BSN · Oct 31, 2006

Recalling an incident in our hospital involving a new nurse........DON'T EVER PUSH POTASSIUM!!!

Anyone remember the days when the nurses on the floors had to add all the meds to the maintenance fluid bags? i do!!! I was a young teen admitted to the floor, and will never forget the day that the nurse hung the bag of fluids up after she added the potassium. i watched her squirt it into the bag, stick the orange label on it, and then hang it up.

I've never in my life had my arm hurt so bad!! It felt like I had been shocked by electricity and I screamed outloud!! She immediately clamped the IV - THANK GOD! - and took the bag down and shook it up. She felt soooo bad. Luckily, I was okay. It could have been a far worse outcome.

Every single time I had to have a new bag of fluids after that when I saw the sticker on the side of it I made the nurses shake the bags. I didn't care if they said it had already been done or not, I made them do it again.

OUCH! It still makes me hurt and shudder to think of that experience! :devil:

nuangel1, BSN, RN · Oct 31, 2006

I have an IV drug book; has dilution, amount, time, etc. Even ones I've given before I frequently look up, only takes a few seconds to look up.

may i ask which drug book or point me in the correct direction.thanks

nursemary9, BSN, RN · Oct 31, 2006

Hi

We also, have taken all Potassium off of our floors.

We have really very few meds we can push-- except for the ICU's;

There are more drugs we Chemo Certfied nurses can give,of course.

Mary Ann

Mulan · Oct 31, 2006

I My favorite IV Med book is Intravenous Medications: A Handbook for Nurses and Allied Health Professionals (Intravenous Medications, 20th Ed) by Betty L. Gahart, Adrienne Nazareno. I buy it every 2 years and use it all the time. It easily identifies dose, dilution, compatibilies, and rate of administration.

I use the same book, have the new 2007 edition, have it with me all the time in my work bag, got it off of amazon.com. (my last one was 1996, about time I updated).

You can very quickly look up dilution and time of administration.

MrsMommaRN · Oct 31, 2006

The book we were required to purchase for clinicals is also a book that is kept on the floor of most hospitals we have done rotations in......

Intravenous Medications A Handbook for Nurses and Allied Health Professionals

22nd Edition

GatorRN · Nov 1, 2006

Yup, I keep that same IV meds handbook in my bag along with my standard drug guide. I look up ANYTHING I have ANY doubt whatsoever about, even if I've given it a hundred times. Can't be too careful when it comes to IV pushes.

I've seen many nurses push Morphine without diluting it, it was beat into my head in nursing school to NEVER push undiluted Morphine, and to push it over 5 mins. I made up a note card of the IV meds I give most often and keep it in my pocket for quick reference.

crb613, BSN, RN · Nov 1, 2006

Anyone remember the days when the nurses on the floors had to add all the meds to the maintenance fluid bags? i do!!! I was a young teen admitted to the floor, and will never forget the day that the nurse hung the bag of fluids up after she added the potassium. i watched her squirt it into the bag, stick the orange label on it, and then hang it up.
I've never in my life had my arm hurt so bad!! It felt like I had been shocked by electricity and I screamed outloud!! She immediately clamped the IV - THANK GOD! - and took the bag down and shook it up. She felt soooo bad. Luckily, I was okay. It could have been a far worse outcome.
Every single time I had to have a new bag of fluids after that when I saw the sticker on the side of it I made the nurses shake the bags. I didn't care if they said it had already been done or not, I made them do it again.
OUCH! It still makes me hurt and shudder to think of that experience!

We don't have pharm at night so we still add our K+ :trout: . I always double check w/another nurse, have them watch me, & shake the crap out of the bag! We carry the K+ in our pocket & never set it down anywhere....then waste it at the end of the night. We had a code in ER the other night... my charge came back & told us the ER doc tried to get them to push 40 meq of K+!!!!

MiRnSoon · Nov 1, 2006

"In Australia the containers that hold pottasium are similar to the ones that hold sterile water and normal saline, (10ml), only the colour of the writing is different. I hope this is changed soon."

Why do you have K on the floor? That's just asking for a sentinel event. All of our K is kept in the pharmacy and only sent out if diluted, ie piggyback, large volume. Yikes!

ER1010 · Dec 7, 2006

One of my preceptors told me that I can just rapid push IVP meds into IVF without concerning myself with the rate that they are supposed to be pushed b/c it will be delivered to the patient at whatever rate is set on the pump. (In other words, I could push Lasix into a line going at 60cc/hr or less.) Is that true?

Also, do I ever have to worry about what type of fluids I am pushing into? Can I push any IVP med into any type of IVF (normal saline, 1/2 normal, D5W, D51/2, LR etc.)?