When to dilute IV push meds ???

[RNNC2003]

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??

[tlhubbard]

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.)?

No you cannot just push a med and let the pump do it. You have to consider if you are using a port above or below the pump. If below, then you are not getting control from the pump for the med, if above the pump you could cause back flow into the maintenance bag and really lose it's effectiveness as it could take HOURS for it to get to the patient.

Also you CANNOT push any IVP into any IVF. You may cause a precip. or otherwise effect the stability of your med. You should always be sure you are dealing with a IVF that is considered compatible according to the insert or your pharmacist. Best of luck!

[RazorbackRN, BSN, RN]

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.

Yeah, that was beat into my head also, however, there are always exceptions to the rule.

For example, I work in a burn unit. If we were to push our Morphine over a 5 minute period, most of our patients would be going nuts. It is not uncommon for us to give 10mg Morphine q hour along with 100mcg Fentanyl q 15 mins. I'm not saying that we "slam" it in, but you have to take into consideration the patient and their condition.

If you have a person in a dressing change, resp. depression is much less likely than someone who is just lying in bed hurting. Although all of our patients are kept on Sp02 monitors.

[P_RN, ADN, RN]

Rather than making your own reference card.......how defensible is that anyway......your pharmacy should provide a chart/grid of compatibilities, non compatiblilites and dilution type and amount.

All meds cannot be diluted with saline, some not with sterile water. There needs to be a consistency among the staff and having a central reference is better in my opinion. That way you're all on the same page.

[rita359]

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.)?

I believe your preceptor misled you. Look the drug up you are giving. Don't give any faster than recommended. It has been practice not to give phenergan without diluting in 10cc ns. Last I saw in a nursing magazine they were recommending diluting it in 50cc ns as a piggyback and giving over 15 minutes though I haven't asked pharmacy about this and haven't seen it done it may become standard practice soon. Do not give dilantin into any solution than ns. Do not give any drug into a heparin drip. Do not give any drug into transfusion. Mother-in-law almost coded from Demerol rapidly pushed so I try to be careful with everything. I don't give any narcotic without diluting and giving slow.

[leslie :-D]

i carry my own, current iv meds book and quickly look it up.

good literature will tell you if it's an irritating med.

will definitely tell you its' compatibilities/non-compatabilities.

should also tell you if indicated to push over certain amt of time.

i never go by another's word.

my handy dandy book serves me well as a reference.

leslie

[AnnieOaklyRN, BSN, RN, EMT-P]

I do not really think which ones to dilute are going to be something you can remember except when you give the drug frequently. I know the FDA just released a warning about phenergan and that it should be diluted when pushed through a peripheral IV as it has cost a few patients their fingers and I beleive a hand becuase it is so caustic to veins

[Gennaver, MSN]

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.)?

Hello,

I am still a pre-NCLEX student, (graduate in June 2007) and please do not trust what that preceptor told you!

Yes there are concerns about what the fluid is that you are pushing into because everything is not always compatable.

Phew, glad you didn't listen to her and that there is a thread here to ask.

Gen

[rehabhereIcome]

Total lame question I am sure...but I have NEVER pushed a med...never had the opportunity...not in home nursing. AND... It was certainly NOT taught in school. Anyhow...I will use this for example.

"If Gravol I.M. is required for i.v. use, it must be diluted at least 1:10 with a compatible physiological solution such as sterile saline or 5% dextrose in water, to prevent propylene glycol-associated serious adverse reactions, and should be injected slowly over 2 to 3 min."

What does that mean exactly...1:10.

How much of the saline solution would I be drawing up?

If 1ml is ordered(50mg), just for example.:imbar

[litbitblack, ASN, RN]

Total lame question I am sure...but I have NEVER pushed a med...never had the opportunity...not in home nursing. AND... It was certainly NOT taught in school. Anyhow...I will use this for example.

"If Gravol I.M. is required for i.v. use, it must be diluted at least 1:10 with a compatible physiological solution such as sterile saline or 5% dextrose in water, to prevent propylene glycol-associated serious adverse reactions, and should be injected slowly over 2 to 3 min."

What does that mean exactly...1:10.

How much of the saline solution would I be drawing up?

If 1ml is ordered(50mg), just for example.:imbar

I would think 10cc of whatever diluent

[ONCRN84]

ALWAYS DILUTE PHENERGAN!!!! If that's the only drug you always remember, remember it!! Phenergan is a vessicant and can cause extravasation injuries which are absolutely terrible.

If it's a new IVP for me, I look it up. But we have a LOT of regulars. Ativan, Phenergan, Zofran, Reglan, Compazine, Haldol, Morphine, Dilaudid, Fentanyl... Once you do them enough and look it up the first couple times, doing it the right way becomes second nature.

Don't stress about it. You'll get it!