Another irritating how to question - page 2

What is the correct procedure,its not in our P and P,for giving a prn MS push for pain through a mid-line when the Patient is having continous fluids thru the line? Stop the infusion,push the... Read More

  1. by   Sleepyeyes
    PS Don't forget to dilute the MSO4. I think the ratio is 1ml of NS per 1 mg of MSO4, via a 10 cc syringe.
  2. by   JohnnyGage
    Originally posted by Sleepyeyes
    PS Don't forget to dilute the MSO4. I think the ratio is 1ml of NS per 1 mg of MSO4, via a 10 cc syringe.
    Does anyone really do this? Around here (in every hospital I've worked in) we just use the morphine directly from the prefilled syringe...

    I don't think I've diluted morphine since nursing school.
  3. by   zambezi
    In the hospital that i work in, we just push from the prefilled syringe, we do not dilute it...unless of course we are putting it in the port of an iv that is currently running
  4. by   passing thru
    I think it is a courtesy to the patient to dilute it. Ever had a "Hit" of morphine? It is an awful- god-awful feeling...your stomach flip-flops and your eyes cross and you stop breathing for a few seconds, ...many patients will sit straight up in the bed and many will feel nauseous for at least 20 minutes.
    Diluting and slow pushing prevents the stomach flip-flop.

    Same deal with solu-medrol and all steroids, the docs told us a direct "HIT" of steroid wreaks havoc to the adrenals. If it were you or your kid, you would want it diluted and slow push.
  5. by   JohnnyGage
    Originally posted by passing thru
    I think it is a courtesy to the patient to dilute it. Ever had a "Hit" of morphine? It is an awful- god-awful feeling...your stomach flip-flops and your eyes cross and you stop breathing for a few seconds, ...many patients will sit straight up in the bed and many will feel nauseous for at least 20 minutes.
    Diluting and slow pushing prevents the stomach flip-flop.
    I've never had anyone complain of these feelings when given morphine -- and I've always asked both during and after administration. I don't recall ever feeling it when it was given to me either...

    Not that I don't belive you, I've just never encountered it.
  6. by   ohbet
    About not diluting MS with IV push,and keep in mind Im asking this question with very limited nursing experience in regards to different settings,but...if the manufacturer indicates the MS should be diluted...say for every 2mg dilute with 5cc,or whatever it is,why wouldnt a nurse dilute it? were not being lazy are we?Wouldnt diluting the MS be a clinically sound practice? If it didnt make a difference whether its diluted why would the manufacturer indicate it should be diluted? Because ,when say an individual nurse doesnt give it diluted and no adverse effects occurr,is this still the best practice?Isnt a nurses own experience or that of colleagues less reliable than research?
  7. by   Sleepyeyes
    Well, I only said that because when I started this job, my drug book said nothing about diluting phenergan or other drugs, and now the newer ones recommend that quite a lot of drugs be diluted.

    Like Demerol, Dilaudid, Phenergan, or Morphine, for instance. If I'm giving 1/2 ml through a 10 ml syringe, it helps me give it slower, too, if it's diluted.
  8. by   JohnnyGage
    I dunno... I think in some cases both drug books and manufacturers can be over-cautious -- also because of FDA approvals.

    Just becuase it's in print doesn't automatically make it correct.

    Take Haldol for example. Haldol can be given IV. I've worked in many hospitals and never have I run into any objection to giving Haldol IV, nor have I encountered any problems giving Haldol IV. Doctors have been prescribing and nurses have been giving Haldol IV for years. According to the manufacturer, however, it isn't supposed to be done, and according to many drug books as well.

    Now this isn't to say that you can take the books and throw them out the window. It means that you shouldn't always read things as gospel. Just a thought.
  9. by   ohbet
    Well I guess I just need a broader range of clinical experience so I can be confident enough to ignore the recommendations
  10. by   copperd
    The iv drip that is going will dilute the Morphine. You do need to dilute it if you have to flush before and after. Also if it is a hep lock, you will need to flush before and after and dilute it.
  11. by   P_RN
    What copperd said exactly.
  12. by   boggle
    I'm not sure of your terminology here. Please, what is a "midline " IV? Is this known by another name?


    As for whether to dilute or not: If the manufacturer and drug book say to dilute, then you dilute. That is the standard of practice. Anything different is beyond a nurses scope of practice and wouldn't hold water in a court of law.
  13. by   ohbet
    boggle, A Mid line catheter is placed in the basilic or cephalic vein.
    Your point about following the manufacturer recommendations and our scope of practice is well taking,however,according some of these posts going to court would be a irrelevant point as it seems giving the MS without diluting it causes no harmful effects.
    Thanks

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