First off, let me start by giving a shout out to all the nurses that are caring for patients in this healthcare crisis. Nursing was stressful before the pandemic; I only imagine the stress that you are working with so please take care of yourself.
Secondly, I want to talk with you about IV push opioids and simplifying the administration. The majority of manufacturers of opioids do not recommend dilution. The drugs are provided in ready-to-administer (RTA) syringes to decrease the manipulation of the sterile medication. Despite this fact, many nurses have been diluting opioids and are teaching newer nurses this unnecessary and potentially unsafe practice. When you remove the sterile medication from it’s ready to administer syringe and transfer to another syringe, such as a pre-filled 0.9% normal saline flush syringe, you are creating a possibility of contamination of the medication, an unlabeled or mis-labeled secondary syringe and the potential of altering the medication strength by dilution.
Many opioids are manufactured in a RTA Carpuject™ Luer Lock Glass Syringe and if the nurse is unfamiliar with this product and does not have access to the Carpuject holder or has not been taught how to use it, he/she will use the Carpuject as a vial and withdraw the medication from its sterile container into a secondary syringe. If you are unfamiliar with Carpujects and Carpuject holders please click this link for more information. Acquiring and learning how to use the Carpuject holder will simplify the steps in administering IV push opioids and improve patient safety. If you don’t have one and your hospital doesn’t supply them (which they should if they are providing you with Carpuject syringes) you may purchase them at Heymed Supply for a penny. They are reusable; just clean them with whatever wipes your facility uses in between patients.
Another fact you may not be aware of is that pre-filled syringes of 0.9% normal saline for flushing (PFS) are approved by the FDA as flush devices only. They are not approved for the dilution or reconstitution of medications. Diluting medications with a PFS is considered off-label use and is not an appropriate practice.
There is also a misconception that you must use a 10mL syringe to administer IV push medication through a central line or PICC line. The Infusion Nurse Society (INS) clearly state in their guidelines that once you have confirmed patency with a 10mL flush syringe, you may use the appropriate size syringe to administer the medications followed by another 10mL flush, administering the final flush at the same rate of the medication administered.
Our goal is to help nurses learn best practice for the administration of IV push medications. There are very few medications that require dilution just prior to administration and there should be clear guidance on your medication administration record as to what to dilute, which diluent to use and how much of the diluent is recommended. If you have any questions, please send them to us or just leave a comment, we would love to hear from you and answer any questions you might have.