Mixing more saline with drugs

[explenture]

Say your service carries morphine 10 mg in 1 ml of saline. Is there a benefit to say drawing up an additional 10 ml of saline so you have 10 mg in 11ml etc.? Some have told me that this makes it easier to push or smoother for the patient. Any truth to this?

[AZCEP]

You don't draw up 10 more mL of fluid. That makes the concentration harder to figure out. Add 9 mL to your syringe, so the total volume is 10 mL to make a 1 mg/mL concentration.

It doesn't make it easier for the patient, but it does make it easier to see how much you are giving. I wouldn't recommend using a 1 mL syringe since it is so easy to lose some of the drug.

[Capman]

Well, it's like this Ex'...

It is easier on the veins, but the thing is with morphine is that many locations get it in pre-filled syringes. Many locations have gone away from morphine as well. In Maine, we are using Fentanyl instead of morphine. As I said though, for us it came in pre-filled syringes.

Keep in mind that many meds you can dilute with NSS to a larger volume (say to 10 ml total), which makes pushing it over a couple of minutes easier to calculate.

In your case, don't create 11 ml of solution, but instead if you are going to dilute 1 ml of Morphine into 10 ml of solution, first dump 1 ml of the saline (in a 10 ml pre-filled saline syringe) or if drawing up the saline, draw up 9 ml of saline and the 1 ml of morphine, making it 10 mg of morphine to 10 ml of saline. It keeps the ratio 1:1, making calculations much easier.

I'm curious to know if you are still using morphine and if so, any talks about going to Fentanyl in the future. I'm also curious to know how it is packaged for you.

Thanks, and hope this helps.

[explenture]

We have both Morphine and Fentanyl, just used Morphine as an example. Morphine is in an amp 10 mg/1ml, fentanyl is in an amp 100mcg/2ml.

[Doczilla]

A larger volume makes it easier to push more slowly, which is a good idea with most IV meds (not adenosine, before some wiseass beats me to it). There are times when the higher concentration or high rate of infusion will cause more histamine release and localized itching/hives from the morphine, and this is often lessened by diluting it and pushing slowly. There is also less of a chance that the ambo will go over a bump and you will inadvertently push the whole thing too fast. Many of the nurses dilute the meds before pushing them, and many do not. And I agree with the concentration/med math thing. 10cc makes things awful easy.

'zilla

[AZCEP]

We have both Morphine and Fentanyl, just used Morphine as an example. Morphine is in an amp 10 mg/1ml, fentanyl is in an amp 100mcg/2ml.

I'd recommend drawing your fentanyl into 10 mL as well. That would give you 10 mcg/mL, just to make the math easier.

[firedoc5]

If the serum of almost any medication is a heavy oil base it is easier to push, especially if it's IM. I use to have allergy shots and a couple of those went in so much better and less pain when diluted.

The prefilled syringes in the field was a God-send. But there were a couple of meds. which weren't and you had to fill them from the vials, Narcan comes to mind first. It would take five vials of 0.4mg to get the 2.0mg that was normally ordered. Sometimes I'd dilute it, and sometimes I wouldn't.

[akroeze]

If the serum of almost any medication is a heavy oil base it is easier to push, especially if it's IM. I use to have allergy shots and a couple of those went in so much better and less pain when diluted.

The prefilled syringes in the field was a God-send. But there were a couple of meds. which weren't and you had to fill them from the vials, Narcan comes to mind first. It would take five vials of 0.4mg to get the 2.0mg that was normally ordered. Sometimes I'd dilute it, and sometimes I wouldn't.

They make 2mg vials of narcan.

And it's a lot to be giving someone in one dose... I know, you only have what you're ordered but that's a lot.

[firedoc5]

They make 2mg vials of narcan.

And it's a lot to be giving someone in one dose... I know, you only have what you're ordered but that's a lot.

I would run part time with other services for buddies, mostly private services, and they had the 2mg. vials. I don't know why the pharmacy at our resource hosp. kept resupplying us with the .4mg ones.

[fiznat]

I don't usually mix saline into the drugs I give, with the exception of Ativan and sometimes D50. Both of those are pretty thick and sometimes go a little easier with the addition of a little saline. I also dilute Promethazine as it is required by our protocol (12.5 mg in 10cc). Magnesium goes in a 100 bag NS for asthma and that's about it except for the standard drip drugs.

As far as diluting solutions for the sake of a slower push-time or whatever, I usually don't have the time or desire to do that.. I'd rather just push the syringe slowly than have to play erector set and draw/re-draw/mix stuff in the back of the ambulance.