Our acute care facility utilizes pre-filled normal saline syringes.  We also had blunt needles.  Example:  When nurses needed to give a small dose of Ativan IVP they would draw up the Ativan into a syringe using a blunt needle and then transfer the med or aspirate the saline into the syringe using the blunt needle.  The facility has now eliminated the blunt needles since contracting with a different needle company and nurses are crying fowl because the "new" blunt tips will not fit into a syringe.

My advise is to dilute using a mult-dose vial of 0.9% NSS or if the continuous fluid is compatible to aspirate contents into the syringe from a y-site and then push the drug over time.

Any thoughts or suggestions??

 Great, a very important

 Great, a very important aspect of infection prevention. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

I shouldn't have said if, the

I shouldn't have said if, the better word would have been when.   I definately understand the importance of one time one patient. 

Again, thank you. 

 There is no IF on the use of

 There is no IF on the use of a vial of medication and saline. It is a one time, one patient use, always. Vials can NEVER be shared between patients, ever! The only safe way to use a multiple dose vial of any solution is to have it dedicated to a single patient and this is not practical in a hospital setting. It would work in a home care setting only. 

Use a 3 mL syringe and draw up the drug so you can measure it correctly. Then insert the needle and syringe into a single dose vial of saline and fill the syringe with 2.5 mL of saline and inject it slowly into the VAD. Discard the vial and remaining saline!! What drugs in this volume would require more dilution? I am going through a mental list of drugs and can not think of anything in that small a volume that would require more dilution. Heparin bolus does not require dilution. Certain pediatric doses might but you would not be diluting in volumes such as 10 or 20 mLs. Again, you must have access to a good IV drug book and in my opinion, the only acceptable one is Intravenous Medications by Gahart and Nazareno, published annually by Mosby. All dilution information is included in that book, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

more questions

Could you explain the procedure if I wanted to dilute the medication using a single dose saline vial.  For example; how would I dilute .25mL of medication. I think it might be fairly easy when a medication dose is 1mL; a 5 or10mL syringe could be used but with small doses of med what size syringe is appropriate?  Which is drawn up first, medication or saline?  Would needle need to be changed if medication vial and saline vial were single use for the one patiient?  If the patient has a running IV I understand how dilution can be obtained with the running IV but what about a small dose of med with a saline lock?

Thank you very much in advance for some insight into this.

Celia

 

IVP meds

This is very clear! Thank you, Lynn.

 First, you must assess the

 First, you must assess the primary fluid for the presence of any medications, electrolytes, vitamins, etc. in that fluid container. Then make sure that the medication in the primary fluid is definitely compatibile with the IV push med. If you find adequate documentation of this compatibility, you can proceed. If you find a compatibility or no information, you must alter your method. If no compatibility problems are identified, you can use the flow rate of the fluids to provide additional drug dilution as you slowly inject through this infusing fluid. You can also dilute the medication in the syringe by drawing up saline from a single dose vial. Multidose vials or bags of IV fluids should never be used as the source of solution to dilute medications in a syringe. The risk of infection is far too great. If you do find compatibility issues or no information about the specific drug combinations, you should always stop the infusion of the primary fluid, flush this fluid from the line with plain saline, attach the syringe with the diluted medication, slowly inject, flush with plain saline again, then resume the rate of the primary fluid. You also must assess for a blood return from the catheter before you give any medication. The blood must be the color and consistency of whole blood. This is a major component of a complete catheter patency assessment. Hope this is clear. Thanks, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

diluting IVP meds

Hi Lynn,

Can you explain a little how you dilute a medication by aspiration of the primary fluid?  Does this mean to pull back fluid from the y site into your syringe that has the medication in it?

Using a multidose vial of saline isn't good practice is it?  What is the best practice to dilute a dose of medicine you are giving via IV push?  I totally understand that the prefilled NS syringes are not to be used.

Thank you

I am a little confused by

I am a little confused by your description of the transfer. If you are saying that the prefilled syringes were used to draw up and dilute medications, this practice is very bad!! I have published about the problems with this and will attach to this message. Look for the second article in this issue of the newsletter . A multidose vial of saline or aspiration of the primary fluid is the acceptable method for diluting drugs. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861