Another irritating how to question

nimbex, RN · Mar 11, 2003

Yep, agree with the above, as long as the line is a maintenence fluid like Ns, D5, slow push the mso4. but not with cardizem, heparin.... other meds that would consider a bolus, that would affect therapudic levels, despite compatability.

good question

Sleepyeyes · Mar 12, 2003

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.

JohnnyGage · Mar 12, 2003

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.

zambezi, BSN, RN · Mar 13, 2003

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 :)

passing thru · Mar 13, 2003

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.

JohnnyGage · Mar 13, 2003

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.

ohbet · Mar 13, 2003

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?

Sleepyeyes · Mar 13, 2003

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. :)

JohnnyGage · Mar 13, 2003

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.

ohbet · Mar 14, 2003

Well I guess I just need a broader range of clinical experience so I can be confident enough to ignore the recommendations

copperd · Mar 17, 2003

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.

P_RN, ADN, RN · Mar 17, 2003

What copperd said exactly.