[RunnerRN]

Had a patient last week who presented with multiple track marks and NO veins. I'm a pretty good stick, and couldn't even find a spider vein to get a 24 in. She claimed migraine, and also stated that "IM phenergan doesn't work for me." Said only thing that worked was IV Dilaudid and Phenergan. I've never run across a true instance of an IM med not working well when the IV form does...maybe takes longer, but still usually works. What is your experience?

[TheCommuter]

Some people are truly addicted to the 'pop' of the needle. IM shots hurt the heck out of them due to hyperalgesia, but they'll poke and prod themselves 50 different times until they can find a vein.

It's not that IM administration doesn't work for this patient. It simply seems that this patient prefers the good 'ole puncture of a vein. At least this is my conjecture.

[TX_ICU_RN]

I don't think the IM route is what this patient came in for. Because IM works over time, she does not get that "high" that comes with the IV administration.

[StNeotser]

Without wanting to sound judgemental, what TX ICU RN said.

[elkpark]

Originally Posted by StNeotser

Without wanting to sound judgemental, what TX ICU RN said.

Ditto ...

[Diary/Dairy]

Ditto!

[SillyStudent]

[nrsang97]

I have to agree with everyone else.

[loricatus]

Let's say you were able to get IV access on that pt. & were to dilute the dilaudid in 50 ml bag and run it in through tubing. I would bet that your patient would have found a way to complain about it because (as most everyone else has said) they are 'seeking' the high that comes from IVP.

I have actually had a couple of these type of patients say that they were allergic to saline, in a manipulative attempt to not have me dilute the narcotic med. I then ask what happens to them when they get saline & follow it with something to the effect of...are you having those symptoms now because you just had 10 cc of saline flushed in after that IV was placed; but, if you wish, I'll just take the IV out and draw up your med for IM because we cannot place an IV if you can't have saline & IM is the only method for those that have saline allergies.

All I can say is that after time, you will start to see a common behavior pattern (related to manipulation) for many drug seekers. With the proper type of questioning, you can usually get them to contradict themselves.

[cccnurse]

OK...
Just wanted to get in here before the "righteous" did and start bashing us "bad" ER nurses because we also have the ability to assess BS.

I agree with everybody so far. My experience has been that they don't think they are actually getting what they want if they can't feel the burn. My reply to them in this IM vs IV situation would be that... IM administration of this medication is safer than IV, this is the way it was ordered by the doctor, if you don't want it IM you are refusing treatment and may now leave.

I usually hear some crap about how I am refusing to care for the pt, but I don't bite. I just calmly explain that they had been seen, treated and released by the doctor, this is the treatment he ordered. You have the right to refuse this treatment and may still be on your way.

I've found out that AMA paper work is just as easy to fill out as discharge instructions.