Circumstances Under Which IV Push Medications Can or Cannot Be Diluted

Some medications administered via IV push require dilution, mainly to decelerate the rate of administration and to enhance comfort for the patient. Other medications, however, should not be diluted due to stability issues or possible alterations in drug efficacy.

When Dilution Is Required

Several classes of drugs may require dilution prior to IV administration.

Chemotherapeutic agents. Many anti-cancer drugs, such as Methotrexate and Adriamycin, need to be diluted to lower their concentration and reduce possible irritation to blood vessels.
Vasoactive drugs like Dopamine and Epinephrine often require dilution to ensure precise and controlled dosing to patients.
Potassium chloride is generally diluted due to its propensity to cause venous discomfort when delivered at full concentration.

When Dilution Should Be Avoided

Certain medications can’t be diluted due to risks associated with stability or efficacy alterations.

Insulin, specifically regular or rapid-acting insulin, is usually given without dilution so as not to affect the accuracy of its concentration.
Vasopressors, such as Norepinephrine, have critical dosing and should not be diluted unnecessarily due to the risk of errors in dosing concentrations.
Benzodiazepines like Diazepam may precipitate when diluted; therefore, it’s critical to administer them undiluted.

If you’re unsure about medication dilution, consult the manufacturer’s guidelines or seek advice from pharmacists. Patient safety should always be a top priority.

Methods and Best Practices for Diluting IV Push Medications

When IV push medications need to be diluted, there are proper steps to take and best practices to follow.

Step-By-Step Dilution Process

First, review the medication’s package insert and label to find out if dilution is needed, recommended, or not allowed. Also, ensure compatibility with the diluent, which typically is normal saline or sterile water. Be careful not to expose the medication to light if it is photosensitive.

Use an aseptic technique when handling IV medications. Always wash your hands, maintain a sterile work area, and use clean gloves.

To dilute, draw up the recommended amount of medication into the syringe. Then, withdraw the correct amount of diluent. Mix the solutions by gently swirling the syringe.

Inspect the syringe. There should be no particulate matter or discoloration. Record the type of medication, the amount, and the time of preparation. Mark the diluted medication with the expiration date and time.

The IV Push Method

When giving the IV push, first clean the IV port with an alcohol swab. Attach the syringe to the port and inject the diluted medication slowly at the recommended rate. Remember, some medications need to be pushed over one minute or longer.

Best Practices for Safety

Most importantly, double-check medication orders and dosages. After administering the IV push medication, communicate changes in the patient’s condition with your healthcare team. Most medication errors happen due to miscommunication.

Documentation is crucial to ensure patient safety. Immediately after the IV push, document the medication, dose, route, and time of administration. Also, include your nursing assessment and the patient’s response.

Monitoring your patient is crucial. Each medication varies in how fast side effects can occur, but always stay vigilant. Remember, the patient’s safety is the ultimate priority.