Diluting IVP Natcotics?

We did not have a policy when I was at the bedside but I always pushed meds over a couple minutes.

If a patient complained I call them out on it. I would tell them the only difference between a fast push and a slow push was the rush. I then told them that the rush was what attracted addicts to drugs and I was doing everything I could to keep them out of a situation where they might wind up "accidentally addicted" to pain medicine.

I would still get some grumbles but that usually stopped the complaining.

I like it! It's all in the wording í ½í¸Ží ½í¸

Dilute it and push slow. That's the recommended way. Patients grumble over everything.

I'd never be able to getaway with scottaprn's response where I work, but there are similar ways you can say the same thing.

It IS all in the wording.

Besides, patients will say anything to get you to do what they want. It's your job to follow the rules.

I only recall one pt who had issues with the way I gave her dilaudid. The first time, I pushed it thru the port with her continuous fluids. That upset her bc "they" always disconnect the tubing & then use a flush. "Please, please do it that way next time. It doesn't work fast enough this way. I should be feeling it by now.

So next time around, I diluted in about 5 ml saline, gave it at the PIV & reattached the fluids. "Aren't you going to flush it?" Um, the fluids are flushing it right now. "But it doesn't make my chest burn. That's how I know it's working". Yeah, that's not good. I'd like you to not stop breathing, ok?

Thanks for some feedback. Many of my coworkers think I am weird for diluting, and seem to do most of what the patients want- so they don't have to discuss things / deal with someone becoming obnoxious.

I guess I'm NOT the "only nurse that dilutes medication" after all!!

I think diluting should officially be made "best practice" - so I can site a policy.

* Manipulative patients don't realize this important inverse relationship:

... The more particular they are about their IVP meds... the longer I will stand there pushing your dose (Policy says over 2-3 minutes? Better make it 3 to be safe ;-] !!!!!) Oh, and I won't even THINK about giving that prn a little early. Not even ONE minute early. NOPE!

*thanks forgetting me vent

Not going to lie, I just don't want to make my job more difficult and I don't want to get in a rough spot with management, so I don't dilute my narcs at all.

My patients are on continuous pulse ox monitoring and tele. I will push their drugs as fast as they want me to. It makes my job easier so I don't have to sit there arguing with a contentious patient all night, and I don't have to worry about management breathing down my neck about too many patients complaining about me.

I dilute all narcotics in a 10cc NS flush. Depending on the patient, I may push it slowly or a little faster. It doesn't phase me anymore when a patient complains, "What are you doing? The other nurses never do it like that". I just tell the patient that they are receiving the same dose of the drug, and this is how I always administer medications because per our policy we are to dilute + administer slowly to prevent adverse reactions, for the patients safety. I will say that I can't speak to another nurses actions, but only for my own.

Always dilute. But unless they are in heart failure, I always have IV fluids running.

So true Dudette, I've never had a pt say, "why are you pushing my Lopressor so slow?"

PBeing a nurse with chronic pain this is hard for me. I often gave the same speech on they were getting the same amount, etc until an inpatient stay changed my mind on this subject.together the nurses, dr and I found a good regimen that worked well.until a nurse came on for his 12 hour day shift. Suddenly my pain was not being relieved.well at all. I made sure the dose and med was the same but all day I was in a lot of pain. On the last push of his shift i and the ruse he was giving report to on me noticed he had diluted the. 1mg of dilaudid in a rather large amount of saline(I'm not sure howuch exactly sn was used to dilute as I didntt notice until the coming on nurse asked if i had bad veins or why was he diluting it so much. As soon as the next night dose was given not diluted but pushed slow the normal pain relief came back. I will forever be convinced diluting narcotics can effect efficacy. I'm still carful not to push to fast as nobody wants vomit or bad stats to deal with but i just flush if needed rather than dilute. (My screed name notaseeker comes from being accused of seeking drugs and bc I know medical info & terminologyI have bn told nurses get addicted often" and finding pain mang. As a nurse is hard too