Pushing Dilaudid?

<< Yes of course I leave the room. I don't see how it would be an issue as it is in a bag so the patient isn't going to take it. It's not like a PCA where there's a huge syringe full of narcotic so we have to lock it. Even if they were to take the bag down what would they do with 50cc of fluids mixed with dilaudid? Drink it? >>


Lol.. yes they will drink it. I've seen it more than once. I also saw a guy attempt to drip it in his eye when I sat it on the table to open a pill package. I would never.. ever..ever mix dilaudid in a fluid bag. Too much room for error...and too much hassle also. I'm already freakin' busy as it is, lol. Just push it slow, or better yet, mix it with a couple of 10ml flushes and push slowly.

I've never heard of hanging it over 15 minutes if the patient is reporting better relief with this strange set up than perhaps they would benefit from a PCA.

But think about it intelligently, drug addicts aren't logically thinking for the most part they will get it anyway they can and it's your license in jeopardy.

Honestly I push dilaudid slowly as it's ordered and I've never put anyone in respiratory distress. I have used my nursing judgment and given less than the ordered dose due to size, loc, and/or age.

Off topic... I walked into a room of a patient who wanted to leave the hospital AMA. I left to get the papers and when I returned with the papers, the doc, and the social worker we caught him taking his IV bag and dripping the contents into a Styrofoam cup! The IV bag contained VANCO!!! I asked him what he was doing and he stated he was trying to figure out what he was getting because he wanted to leave and maybe he could get it some where else by taking the cup and having it "analyzed". I never once thought he was telling the truth and was confused up until I read the responses of the others...

Now my guess is that he planned to drink the rest of his dose, administer it some other way, OR sell it! Don't put anything past patients, especially those with a past drug addiction history... They think they know more about drug administration then they actually do!

Maybe you are the one that needs to get more experience when it comes to dealing with handling narcs. You might not lose your license, but you might lose your job for not following facility policy and procedure. Your license could be reprimanded if your patient took down an IV and drank it if you were not following facility policy.

Others have posted how this is a waste of money using a 50ml bag of saline. Others have posted how drug addicts are illogical. That is the truth. They might not get high by drinking a 50ml saline with 4mg dilaudid, but many drug addicts don't know that. Many drug addicts tend to have drug addict friends who would have no problem sucking the dilaudid right out of that IV bag themselves if they could. I have seen nurses administer vicodins to patients just for them to spit them out as soon as the nurse left the room. They then went and sold these pills. I have also seen patients spit vicodins out in order to save them so they could take a larger dose at the same time. The same thing can happen with a 50ml bag of saline with Dilaudid in it.

if they've had it before and the same dose as before, slam it within the hosp policy or your guidelines and be done. Hospital admissions where the treating diagnosis is not addiction; nurses have no standing to try to treat and control narcs if a patient is in pain. Hanging it in an IV? I'm happy I'm not there!

If I'm in pain, give it to me over a minute or slam it or whatever...who cares?

So they get a high feeling at first; big deal. That's what narcs do!

Hanging it in an iv to avoid a high is an asinine policy. Push it and watch em and if they get a high feeling, you know it's working. Treating addicts is no big deal if you know how to deal with them but it's apparent the label has more power than reasonable treatment. My guess is a place like that is weaning them day one postop if they've got a tolerance. When it comes to pain relief, I don't mess around. If they say they're in pain or an addict that's in pain (addicts have pain, too) then I don't delay, give whatever it takes within the standing and scheduled orders enough to stop their voicing pain. It's soooo easy!


If they need to address their addiction it will be initiated by them when the time is right and that's where I come in. Post acute admission is the time to address their addiction. Controlling narcs like control freaks in a physical acute setting WILL create more anxiety and therefore more pain. They should read the pain control guidelines. Pain is subjective but when they're obviously calmed, they bother me less then on discharge day we can address their plan for addiction treatment and instruct them how to wean down at home before addiction treatment.