Can anyone tells me a few situations that you would avoid using IV opioids on a pt?

SamZ · Mar 16, 2011

I have found the answer in the book, thx everyone anyway~~

sairin8 · Mar 17, 2011

Resp rate below 12 in an adult (different rates for different ages in paeds)

K+MgSO4, BSN · Mar 17, 2011

on bupronorphine to get of IV drugs as it inhibits the MU receptors. Hospital policy. I can only give IV opiates in a PCA or for chest pain. The rest of the time they are subcut

carolmaccas66, BSN, RN · Mar 17, 2011

If they are on a PCA many hospitals don't give extra opioids, some doctors do, depends on the patient, their tolerance level to pain, and what dose/drug it is.

A bit off topic but good info to think about when ur a RN.

sairin8 · Mar 18, 2011

I'm realising how it's never "THE" answer; it's usually "AN" answer, one of many...

talaxandra · Mar 23, 2011

The PCA answers are really interesting - I was thinking of that as an IV route and looking more at situations where no IV opiates would be given, rather than no PRN dosing. Our PCA-receiving patients aren't allowed any additional opioids, unless they're transitioning off the PCA and need additional coverage.

Other scenarios where I'd be reluctant to administer opiates IV include: opiate-naive patients, particularly the elderly; patients with significant renal impairment, particularly if they've already got narcotics on board; patients with significant respiratory co-morbidities or current high O2 demand (unless they had chest pain); and patients with acute cognitive impairment. I'm sure there are others, too.

carolmaccas66, BSN, RN · Mar 24, 2011

I should have said:

If you do give extra opioids with a PCA, you need to FIRST check patient's sats, breathing & heart rate, overall health, use of PCA (these are hourly checks anyway) and tolerance to pain compared to the op performed. For example if patient had a cast on a leg and pain was unbearable, I would be thinking compartment syndrome? do all my assessments, neuro obs etc, grab a Doppler and have a look - don't just give extra pain medication until all assessments have been done.

We had one lady who had a Fentanyl PCA and another PCA - can't remember the drug through a superficial catheter in her side - she was used to having this drug for severe back pain, so she had extra pain relief, but we had to keep a close eye on her sats, etc - every 30 minutes she had to be assessed until stable and/or not using PCA as much. That was a lot of charting and she was a VERY difficult and demanding patient!

Sorry not making much sense - am tired - I need my Milo!!