The official guidelines and regulations surrounding IV push medication dilution primarily come from the Institute for Safe Medication Practices (ISMP) and the American Nurses Association (ANA).

ISMP Recommendations

The ISMP discourages the routine dilution of IV push medications. They recommend this because inappropriate dilution can compromise the drug’s stability and efficacy, potentially lowering its therapeutic effects. However, when dilution is necessary as per the manufacturer’s instructions or the drug’s pharmacokinetic properties, ISMP underlines the use of diluents as suggested by the manufacturer. It is crucial that you adhere to specified volumes in order to preserve the potency of the medication.

ANA Guidelines

The ANA’s position aligns with the ISMP’s stance—dilution should not be the default practice for IV push medication administration. When dilution is required, the ANA reiterates adherence to the manufacturer’s guidelines regarding diluents and volumes. They recommend a slow administration rate for most medications to reduce the risk of adverse reactions.

Legal Considerations

It’s important for you to be aware of state nurse practice acts and institutional policies, as they may have additional or specific guidelines about IV push medication dilution. Not adhering to these laws and guidelines might be deemed as malpractice. Be aware that any deviation from the recommendations or facility’s policies around dilution could potentially expose you to liability if a patient experiences an adverse outcome following medication administration.

Dilution Practice Tips

If a medication is to be diluted, follow these four tips for safe practice.

1. Always review the drug manufacturer’s instructions before diluting an IV push medication.
2. Employ aseptic techniques to maintain sterility.
3. Diluted medications should be used immediately, and any remaining solution should be discarded to prevent the risk of bacterial growth.
4. Date and time labels must be applied to diluted medications if not used immediately.

The Risks and Benefits of Diluting IV Push Medications

When it comes to diluting IV push medications as a nurse, there are a few potential advantages but also a number of drawbacks that are important to consider.

Advantages

While there are far fewer advantages than disadvantages to diluting IV push medications, they should still be mentioned.

Enhanced Patient Safety

One of the main advantages of diluted IV push medications is the potential for enhanced patient safety. When medications are diluted, they may decrease the risk of administering a medication too rapidly or in a concentrated dose, which can lead to adverse effects.

Improved Tolerance

Some medications can be hard for the patient to tolerate when administered in high concentrations. By diluting the medication, you can make the treatment process gentler for the patient.

Drawbacks

Although there are significant benefits to diluting IV push medications, you also need to consider the potential drawbacks.

Error Potential

One key risk is the increased potential for error. The process of dilution requires faithful accuracy. Inaccurate dilution could lead to under or overdosing.

Drug Stability

Some medication’s stability is affected by dilution. A medicine could become ineffective or potentially harmful if it’s not stable after dilution.

Time-Consuming

This process might be more time-consuming when compared to using pre-diluted or direct IV push medications. This could potentially divert time from other important nursing tasks.

Infection Risk

The process of diluting medications may increase the risk of contamination and the potential for infection. A strict aseptic technique is necessary to minimize this risk. While there can be potential benefits to patient safety and tolerance with dilution of IV push medications, it’s also important to consider the risks.