Administering IV meds

[maryjane1216]

I had a patient today who had LR running @ 30 ml/hr. Patient is also on demerol PCA. MD ordered Toradol IV ATC q6h. However, when I looked in the 2008 IV meds 24th Edition by Gahart and Nazareno, demerol and toradol are contraindicated. I asked one of my co-worker and she suggested to flush with 10 ml of NS admin the toradol then flush it again w/ 10 ml of NS. Is there any other way of administering it?

[MIA-RN]

Toradol can be given IM if you need to.

Does the book say why the two drugs are contraindicated? Sometimes it has to do with the compatibility within the tube vs the meds actually not safe together. I just read today in either AJN or Nursing 2008 about IV fluids and compatibility--watch out for LR because the calcium in it can react with some drugs.

Anyway, I would like to know more. Is the PCA running continuously or is it demand only?

I am pretty sure I've given morphine or demerol IVPB or IV push and later given toradol.

[MedicalLPN, LPN]

I would've just flushed with 10ml's of NS between the pushes. You can give Toradol IM but I know with our Doc's they won't order anything IM if the pt has an IV unless if it's something that can't be given IV.

[maryjane1216]

MIA-RN demerol was running as a PCA....

[Balder_LPN, LPN]

Toradol can be given IM if you need to.

Only if you get the doc to ghange the IV order to IM.

[MIA-RN]

A PCA can be set to administer the demerol either only on demand or have a continuous dose plus demand.

If the PCA of demerol was on a continuous running dose, and the drugs are not compatible, it would be more of a problem to co-administer them. Thus my suggestion to give it IM and not stop the patient's continuous pain relief. Not that an IM is any fun for the patient, but if you have a patient in a lot of pain (which you likely do since you are using two pain killers) then if you stop the continuous dose, flush, give the toradol, flush, and then start the PCA up again, you are risking losing the pain control you are attempting to acheive and sometimes, the PCA tubing and the KVO tubing is hard to manage if its not set up correctly at the Y site.

I know that I try to avoid giving IM's when I can, especially if the pt already has IV access, but the OP asked for other ideas on how to administer the toradol, and that is one way.

A far simpler way would be to set up a second IV access and use it just for the toradol pushes.

[purple_rose_3]

Stop the meds, disconnect the tubing. Then flush, give toradol, flush and reconnect NS and PCA.

[morte, LPN, LVN]

A PCA can be set to administer the demerol either only on demand or have a continuous dose plus demand.

If the PCA of demerol was on a continuous running dose, and the drugs are not compatible, it would be more of a problem to co-administer them. Thus my suggestion to give it IM and not stop the patient's continuous pain relief. Not that an IM is any fun for the patient, but if you have a patient in a lot of pain (which you likely do since you are using two pain killers) then if you stop the continuous dose, flush, give the toradol, flush, and then start the PCA up again, you are risking losing the pain control you are attempting to acheive and sometimes, the PCA tubing and the KVO tubing is hard to manage if its not set up correctly at the Y site.

I know that I try to avoid giving IM's when I can, especially if the pt already has IV access, but the OP asked for other ideas on how to administer the toradol, and that is one way.

A far simpler way would be to set up a second IV access and use it just for the toradol pushes.

i, too, would vote for a second iv site. also, by contraindicated, are they not to be administered at the same time (which makes the prior conversation moot) or simply not to be mixed in the same tubing?

[Virgo_RN, BSN, RN]

Do you mean they are incompatible?

[fusster]

I would talk to the pharmacist at your hospital and see if they have any advice. Pharmacists are a wealth of knowledge. They would most likely be able to tell you if the drugs are incompatible or contraindicated and be able to tell you why, helping you to make the best decision possible for your patient. If they are just incompatible, a new line would be the safest bet.

[Blee O'Myacin, BSN, RN]

I had a patient today who had LR running @ 30 ml/hr. Patient is also on demerol PCA. MD ordered Toradol IV ATC q6h. However, when I looked in the 2008 IV meds 24th Edition by Gahart and Nazareno, demerol and toradol are contraindicated. I asked one of my co-worker and she suggested to flush with 10 ml of NS admin the toradol then flush it again w/ 10 ml of NS. Is there any other way of administering it?

I'm surprised that the PCA was Demerol. In recent years, it hasn't been used much due to many contraindications with other medications. I'd make sure that the toradol is safe to be given with the demerol at all. I'm less concerned with tubing incompatibilty issues and more concerned with adverse reactions.

PCA tubing shouldn't be flushed unless you are looking to give your patient a bolus of unknown quantity. If I had to stop a PCA or drip for any reason, I pull back with an empty syringe, aspirate the contents of the tubing and discard. Then I flush and give the IV push med.

I'm more inclined to have an additional saline lock in place for anything unexpected, or for IV push meds or for piggyback abx.

Blee

[Altra, BSN, RN]

I may be reading your post incorrectly, but I'm picturing a patient with a Demerol PCA and an IV with LR running KVO (30mL/hour).

I know of no contraindication to giving both Demerol and Toradol, and I've checked my 2 drug guides without finding any contraindication. If you are concerned I would definitely check with pharmacy.

Since the IV is only running KVO, I would probably just stop the LR for 10 minutes or so and give the Toradol.