No More Demerol IV Push??? - page 4

In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic... Read More

  1. 0
    I received Demerol IM post-op from ankle surgery. I hated it. It only worked for an hour or two, but could only be given every four hours. I had IV access, by the way. I was in pain all night and all the next day. My nurses called the doctor 4 times to change my medication and all he would do is up the dose until the final call when the nurse said "look, she's going home in a few hours, can't we switch her to something PO." He gave me Tylox and it worked! When I went home he gave me lortab, even though I asked for tylox. It didn't work so I asked for Tylox again, and he gave me a prescription for ....Demerol and phenergan. It caused muscle twitches, mood swings and made me MEAN. AND it didn't work any better than the lortab . Not only will I never use that ortho doc again, I will ask that I not receive demerol again.

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  2. 0
    This is all very interesting to me...have been an ER nurse for 4 years now, and we give Demerol all the time! I would say in the last year or so it hasn't been used as much, but some docs will only give that med for pain control (unless there is an allergy of course). I would say we give it IM more than IV (and we definitely have some people who I think are addicted, one who gets 200mg with 50-100 mg Phenergan almost every 2-3 days for migraines!)...but I'm curious as to why some hospitals are completely taking it out of their formulary and others are not. I've never personally seen any of the really bad side effects that have been mentioned in this thread. Just drowsiness, and it not really working in some patients. Dilaudid is the one everyone asks for now. But this will make me think about it the next time an MD orders it, and ask them what they think about this research. By the way, we still stock 50mg, 75mg and 100mg vials in our narc drawer consistently!
  3. 0
    I work at a large teaching hospital. It is still common in my practice to give Demerol IV push. From my experience, however, I don't know that it is any safer (ie. fewer neurologic sequelae) to give it other than by IV push. I recall a case a few years ago where an older teen was receiving Demerol 150 mg. PO, Q3 hours PRN. I no longer recall how many doses she received, but I don't think that she had been on this regimen very long when she began to seize. I believe that the cause of the seizures was thought to be the build up of the neurotoxic metabolite, normeperidine.
    Just my $.02 worth.
    David
  4. 0
    Quote from TaraER-RN
    This is all very interesting to me...have been an ER nurse for 4 years now, and we give Demerol all the time! I would say in the last year or so it hasn't been used as much, but some docs will only give that med for pain control (unless there is an allergy of course). I would say we give it IM more than IV (and we definitely have some people who I think are addicted, one who gets 200mg with 50-100 mg Phenergan almost every 2-3 days for migraines!)...but I'm curious as to why some hospitals are completely taking it out of their formulary and others are not. I've never personally seen any of the really bad side effects that have been mentioned in this thread. Just drowsiness, and it not really working in some patients. Dilaudid is the one everyone asks for now. But this will make me think about it the next time an MD orders it, and ask them what they think about this research. By the way, we still stock 50mg, 75mg and 100mg vials in our narc drawer consistently!

    50mg-100mg Demerol with a 25mg-50mg of Vistaril used to be given ALOT both pre-op and post-op and used alot in the ER's...when did they stop with the Vistaril and change to Phenergan???
    Dilaudid is abused big time...I think its because its so fast acting but also shortly lived...1-2mg IVP Q1-2hrs PRN is not uncommon for a order from some Drs.... We had a ortho patient who requested it around the clock and because the order was there, some nurses just gave it without question...one day I got "nosey" LOL and asked..."Can ya tell me where your pain is located at this moment and on a scale of 1-10 how intense is the pain?" The patient NEVER once told me the pain was in her knee ( she had a partial knee replacement two weeks earlier and was in for Rehab) ...she gave me " Well i have a headache and cramps" Cramps??? Headache??? No history of migraines...just a headache....when the Dr came in I discussed this with him and reviewed how much she was using...Well we prepared for any withdraw symptons and DC'd the med..giving her one percocet every 6 hrs PRN....Guess she knew we were finailly on to her cause she never complained...
    I guess the point I am trying to make here is, No matter what the drug of choice may be, percocet, demerol, dilaudid, lortab etc...just because they have the order, we as nurses DO have an OBLIGATION to our pts well being..No we can never assume the level of pain a patient, but we most certainly can keep an eye of the pattern use and we do have a right to contact the Dr... I refuse to become an enabler...
    Don't get me wrong, I am totally for pain management...its a part of the pts healing process...but I do ask the patient....and I am sorry... some will just ask for it because they know they can have it...
  5. 0
    Until recently I worked mostly in Ortho. I occassionally floated down to the ER. One night I had a woman with pelvic pain, NYD, but not preggers. Demerol 50 mg IVP. I diluted and pushed it slow. Pt's eyes rolled back, and she started to twitch. Completely unresponsive for 5 minutes. Scared the begebers out of me. She came to with no further adverse reactions, but that was the last time I pushed Demerol. After that, I always piggybacked it and it went in slow.

    I had pushed it slow, but not slow enough.

    I now work psych so it is a non-issue at this point, but I will never give Demerol IVP again if I can possibly avoid it.

    On Ortho, I found that they had been getting away from Demerol for the past 2 years. IV nacs (morph/dilaudid) for the first day or 2, then to po (Percocet/tylenol#3). New regime seems to work better. By day 4, pts who were doing well were switched to tylenol plain and Ibuprophen.
  6. 0
    My facility loves Fentanyl which is used about 90% of the time. Then comes MSO4, then the lightweights. I haven't given Demerol IV or IM at all in the 13 months that I have been working SICU.
  7. 0
    Quote from VickyRN
    In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.

    http://ruralnet.marshall.edu/pain/demerol.htm
    http://www.hospicecares.org/Pharmacy...02Pharmacy.htm
    I have heard that The reason for not using Demerol is due to the fact that the Metabolites that cuase ill effects stay in the body longer than the medication controls pain, causing toxic build up.
    I have also heard that there are hospitals that are "Meperidine free zones" for these reasons.
    I work on an Oncology unit where we never use demerol for oncology patients. WE do get medical and surgical patients on demerol IV and /or IM. In my 27 year experience as an RN I've foun Demerol tio be one of the most addictive drugs there is. We end up getting patients in and out every couple months for a lifetime with pain that ONLY Demerol can help.
    I think there are much better and safer options, like morphine with less toxic build up and not as addictive.
  8. 0
    in my last hospital in australia - a major teaching facility - we weren't allowed to give any IV narcotics - ever - everything was given IM - although they did use PCAs

    just for interest sake - I have been a nurse for almost 10 years - usually had no problems with demerol - however one time with a patient who was receiving high doses IV over a long period of time did seize and stop breathing and have to be resuscitated - they blamed it on the demerol - patient had no history of seizure
  9. 0
    We have used demerol for rigors or if there is another contraindication for use of an alternative medication. We have 25 mg vials in Pyxis, but any larger amounts are kept in the narcotic vault in Pharmacy.
  10. 0
    Quote from VickyRN
    In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.

    http://ruralnet.marshall.edu/pain/demerol.htm
    http://www.hospicecares.org/Pharmacy...02Pharmacy.htm
    Vicky,
    Demerol will break down the same way whether it is IV or IM. Demerol is not the drug of choice for the reasons you mentioned as well as - why inflict pain (IM injection ) to relieve pain when there are so many other choices. We still have some MD's that order it and if we can't get them to change the order to a different pain med the patient gets it.
    LK


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