Delivering small volume IV medications

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Randi Trope
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Joined: 06/29/2013 - 21:42
Delivering small volume IV medications

What is the process your hospital uses for delivering IV medications less than 1 mL?

Here's our situation (which I think may be yours too)!
1) Priming volume of tubing is 1 mL
2) When med is, for example, 0.3 mL over 15 minutes, in 15 minutes this med is still in the tubing
3) The flush should run at the same rate as the med which will then take excessive time
4) Some nurses have been running the flush(1mL) over 5 minutes which really means the med is now going over 5 minutes

Solutions we have thought of and problems:

1) Push the med into tubing and add saline to move the med to the end: results in air bubbles from disconnections and hard to see where med actually is
2) Dilute the medication down to 1 mL on nursing end: concern with sterility. This also has issues with Alaris programming regarding concentration limits. We thought of removing the concentration limits in Alaris but this runs the small risk of accidental overdose if the nurse has access to the med (i.e. Pyxis) and draws up too much.
3) Pharmacy prime entire tubing with med and only deliver what patient needs. We don't like this option as the risk of potential overdose is much higher.
4) Pharmacy deliver the meds in 1 mL. This results in multiple potential concentrations.
5) Find smaller tubing!! We can't find any. If anyone has a source PLEASE tell me. The tubing needs to be at least two feet long so the pump is not hanging over the patient (lets not talk about the safety risks of that)!