We read with interest the article by Posgai and Hochstetler,”Pharmacotherapy Considerations for Inpatient Advanced Cardiac Life Support.”1We’re writing to clarify information regarding inappropriate dilution of medications administered via intravenous push. Specifically, the following statement is concerning: “Another option is to waste 1 mL from a 0.9% sodium chloride flush syringe and then add 1 mg of concentrated epinephrine to the flush that now contains 9 mL of 0.9% sodium chloride.”2(p101)The Institute for Safe Medication Practices has identified the use of commercially available prefilled 0.9% sodium chloride flush syringes to dilute or reconstitute medication as an unsafe, off-label use of this product.2,3The process described in the article involves potential mislabeling of a syringe containing medication. The US Food and Drug Administration classifies the prefilled 0.9% sodium chloride flush syringes as “medical devices”; as such, they are not intended or designed to measure medication.4,5 The lines are not accurate measures for dosing, as the markings are often part of a sticker affixed to the syringe, which is not commonly known by clinicians. The 0.9% sodium chloride fluid within the prefilled syringe is not tested as a diluent for medications unlike the 0.9% sodium chloride injection in USP vials, which are classified and managed as medication.2,3,6The appropriate practice for dilution is as follows: (1) intravenous push medication is pulled up into the medication syringe, and (2) the appropriate amount of diluent (as instructed in the administration instructions) is pulled up into the syringe containing the medication. This process should be used unless otherwise specified by the manufacturer.7,8We appreciate the opportunity to express our concern about a nursing practice that many are trying to eradicate. We welcome any further discussion on this important topic.
Colvin et al. (Fri,) studied this question.