When drawing push meds, do you draw the med first?

[anangelsmommy]

ok, I am in my last month of school, and I am trying to clarify something I learned in school. I have tried looking it up and online and I cannot find it. Perhaps I can find either a source here or a consensus among the learned nurses....when you are drawing up your IV push meds that need to be diluted....do you know what the proper what to dilute or can you tell me how you were taught to do it and why? Do you first draw the diluent and then the medication into the syringe? or the medication and then the diluent? for instance 2 mls of lorazepam and then 2 mls normal saline or would you first draw up 2mls of normal saline and then 2 mls of lorazepam? And please explain?

It seems to me that each draw you have the capacity to take in too much of one of solutions, either normal saline or lorazepam. or are you supposed to be pulling back and injecting air so you only take in the amount you need? or are you just drawing back exactly what you need and stopping? I just need to know exactly. I had to dilute medication this week and then was told something very quickly....it didnt make sense and I know I will be asked to discuss next week, I want to make sure for my own and my patients well being that I know everything there is to know about this subject...unfortunately, we dont get a chance to practice this, we just do it in clinical!

thanks for your help!!

angelsmommy!!:uhoh3:

[KyPinkRN]

Actually injecting the medication into the saline flush seems like it would be the most efficient and not lose any of the medication. We have to label all medication so i would not need to attache the vial. We label before leaving the med room. I was told to draw up the saline first but what I was concerned with was if I accidentally drew up too much medication, if must be EXACT, or you could be pushing SALINE AND MED back into the med vial - we throw away the vial anyway but I am more concerned with the patient getting the correct dose.

Or when drawing the med in- would it not mix that quickly? or do you just need to be that exact that you just dont draw in too much. I like this method. I will have to review this with my instructor and see if this is acceptable, this seems like not only a much more safe and effecient but quicker!

angelsmommy

If you are concerned about getting the correct dose... here is what I do: For ex. if I am only giving 12.5 mg of Phenergan, I draw up the exact amount of the med in a 3 ml syringe, then take a pre-filled saline flush and pull back a little so there is room to put in the med, then I take my med syringe with a blunt tip needle and inject it into the saline. You can do the same just draw up your saline in a syringe and then whatever your med is in another. I have found this is a way to assure the patient gets the correct amount of medication every time.

[wlb06]

That's interesting! We don't have saline flushes at my hospital (we don't have IVs) - I'd never have thought of that!

You don't have IVs? No saline flushes? Please explain that one.

[hypocaffeinemia, BSN, RN]

What I do for ativan:

1. Take a 10 cc pre-filled flush syringe.

2. Place blunt needle on it.

3. Expel 1 cc of fluid.

4. Draw up ativan so that total volume = 10 mL.

5. If I need to only give 1 mg I waste half in the sink.

[kcochrane]

I also draw up the med in a blunt tipped syringe and add it to a flush (after pushing a few cc's out).

[meandragonbrett]

Also....there is a difference between diluting medications and reconstituting powdered meds.

For Ativan I dilute in 10ml of NS if it's a periph INT. Same for pretty much anything I give IVP is in 10ml of NS.

[CuriousMe]

This is how I do it, but I am interested in other replies as well as I have never officially been taught a "right" way, or seen any articles on the topic. This is, however, the way I have seen many, many nurses do it.

In the scenario you describe, I would draw up the lorazepam into a syringe first to ensure the most proper measurement. Then I actually take a prefilled flush, empty it of all but my desired amount of saline. Then I inject the drug into the saline flush. I tape the original container to the flush to keep track of what the medication is. I feel like this works well for me and gives me the most accurate dosing.

This is what we do as well.

[~Mi Vida Loca~RN, ASN, RN]

All the nurses I have worked with get a 10 ml saline flush, the kind that come pre packed and ready. Squirt a few mL's out (enough for how much they are drawing and usually over a little) and put a needle on and draw the med from the vial in a separate syringe to add to the flush, label the flush, put a new cap on it and push that. We keep the vial the drug was in to scan for eMar, I have never seen it done any other way.

[~Mi Vida Loca~RN, ASN, RN]

Oh I guess I should add that 99% of the drugs I have seen pushed come in single dose vials and the rare time it's not the right dose the nurse has drawn up the dose and used a connector to repeat the same process and I have never seen any nurse have to reconstitute anything like we were taught in school, it always comes already done so far. (I have passed many meds on 4 different units). In school we were told if reconstitution is required the drug will have specific directions on which way to do what.

[anangelsmommy, ADN, BSN, RN]

yup, seems like this is the consensus...I appreciate the feedback. I will be working very soon on my own at the hospital most likely so this is why I want to know!!:yeah:thank you so much for all your input, I definately think that I can do what I am told for now and do what I am comfortable with doing when I am working! I also do homecare and though I do not do IV push at my job now, there are a few new cases that require RN only that look really good that I may orient to when the time comes!! thanks so much for your feedback, I love allnurses!!

angelsmommy

[K+MgSO4, BSN]

I have never seen any nurse have to reconstitute anything like we were taught in school, it always comes already done so far.

Here in Australia ans in the UK and Ireland nurses have to mix (reconstitute) their own Antibiotics. This requires knowledge of compatibility of fluids to the meds such as pantoprozloe should not be reconstituted with sterile water but saline unlike most other medications which are reconstituted with sterile water. Also because I have to add most of them to a burette you have to know what meds are compatible with the IV fluids you have running.......... most are not compatible with Hartmanns Solution (compound sodium lactate) or with K+ so the med has to be added to a smaller bag at the right concentration and infused.

But to return to the original topic I would say draw up the med first to get an accurate dose and then add the dilutent as it is very low posibility that you are going to damage the med by diluting it too much(there is at least one but it fails to come to mind) but if you draw up too much of the med into the diluent you have to discard both (or over or under dose your pt) causing wastage. Best of luck!

[cherrybreeze, ADN, RN]

All the nurses I have worked with get a 10 ml saline flush, the kind that come pre packed and ready. Squirt a few mL's out (enough for how much they are drawing and usually over a little) and put a needle on and draw the med from the vial in a separate syringe to add to the flush, label the flush, put a new cap on it and push that. We keep the vial the drug was in to scan for eMar, I have never seen it done any other way.

This sounds like what I do, too. Draw up med for accuracy, push a few ml's out of a 10ml saline flush, with needle still on med syringe, push med in to flush syringe, cap, mix, let air out.

As far as the multi dose vial concern, we are no longer allowed to use multi dose vials more than once (be it a med, or a vial of saine, etc). It seems like a big waste, to me, but their reasoning is that it completely avoids the contamination issue. The only exception to this is insulin vials, of course, we use those more than once.

[RedhairedNurse, BSN, RN]

I draw the med in a 3cc syringe, or a 10cc syringe if I'm using Picc line. Then, with the needle still on my syringe, I put the needle into my 10cc of saline and just pull some saline in with my med. And use the remaining flush for the IV. I usually dilute with the same amount as the med.

I've never thought of pushing the med into the flush syringe. That's a good idea except for the druggies I have, they may think they're not getting anything but saline if I did that.