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:

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

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!

Yeah I have no doubt that it's done, I had a med I had to pick up from Pharmacy that needed to be reconstituted for my kid so I know it still happens, those all had very clear instructions on them for how to do it, what to use and how much and what to do first.

But doing the clinicals in our hospital I have never seen it down. I have heard though on the Oncology floor the nurses have to mix a lot of their own meds. I don't know for sure though.

It's interesting how much things are different in different places, I did clinicals at a new hospital tonight and was in the ER. Things done completely different but I really liked it.

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

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.

Yeah insulin is the only one I seen too. Although tonight in the ER I saw them used but things are done very different there. On the floors I have only seen the multi dose insulin and it's only for the PT at that.

[aura_of_laura]

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

We're acute inpatient pediatric psych. Our kids are crazy as heck, but we don't admit them until they're medically cleared. It's very rare that our kids even get an IV in the ER. My advice was actually from my experience with IM meds (which is considerable), I noticed after posting the OP wanted IV-specific info.