I have a patient who, at home, was receiving a continuous infusion of Demerol through a PICC line for undiagnosed abdominal pain. Apparently she is allergic to just about every other pain medication (Toradol, Morphine, Dilaudid, etc.) so the Demerol is her only option. She came in due to line sepsis.
Perhaps I am a little uneducated on this. I thought Demerol was being phased out for the most part due to neurotoxicity. I have not given it in quite some time.
Also, has anyone else cared for a person in this situation? She is walking and around and completely with it. It's crazy.
Feb 13, '13
Is she doing this at home herself? Or does she have Home Health? If her line is compromised, then she needs some education on how to care for her line properly. And I would get social services involved. Perhaps she needs to be in skilled care, and weaned to PO or something. Sounds like a dangerous situation all around. Is she terminally ill? A continuous infusion of any narcotic for generalized abdominal pain from now until the end of time seems a bit over the top and I can't imagine what MD would be on board with this unless this is a terminal patient. However, stranger things have happend. Tread cautiously, and get your nursing adminstration involved with this as well. CYA.
Feb 13, '13
We had a patient for years and years that had a PCA for chronic abdominal pain. She had so many PICCs done we lost count. We tried a few ports but those were worse for her. I hope they used a pump that she is locked out of and only nurses change the bags or cassettes. You do not necessarily need to be terminally ill to have this kind of set up. Look over her history a bit more. Perhaps they have tried other things that not have worked. I know our patient that recently died,was not controlled with anything else but continuous IV narcotics via a CADD pump. Perhaps they intend to use this short term as they try and discover the cause of the pain. We also just send a young non terminal Ca patient home with a PICC and with IV narcotics because she was in too much pain and they could not control it with anything else they tried. How are they monitoring her for neurotoxicity?
Feb 13, '13
She has home infusion services.
She is not terminally ill.
Social work and case management are involved. She will resume home infusion with the same visiting nurse agency when she is discharged to home - which should hopefully be soon because her blood cultures finally stopped growing MRSA long enough for her to get a new PICC.
We are having to give her the Demerol IVP because we don't have Demerol PCA in our hospital.
I have not been her primary but have helped with her as charge nurse so I can't say I've had much time to investigate her history. I was just wondering if this was commonplace anywhere. I've worked in the hospital for 8 years and have never heard of such a thing.
Also, a reputable pain team is in charge of her meds. Psych has seen her a few times and does not have much to add.
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