Diluting IVP Natcotics?

[_Andvari]

Do you dilute your IVP narcotics?

I always dilute morphine and dilaudid- the extra mls in the syringe help me to administer it slowly (over two minutes) - especially with a peripheral. With ativan, I dilute a bit more than the 1mg/ml recommendation.

I have had so, so many experiences of patients bullying me about this practice/ my narcotic administration in general - I hear this constantly:

* "no one has ever diluted my meds"

* "it didn't help my pain- I think it is because you diluted it"

* (with IVF running) "you have to flush afterward, or it won't work"

* "it won't work if you push it that slow- two minutes is too long"

I tell them that they are getting the same amount if medication. I tell them that I administer it at the speed per our policy, blah blah blah- but still- they are angry. I even had a 25 year old patients MOTHER reprimand me about this the other day.

At what point do you cave in for patient satisfaction? I always give it over two minutes regardless of how upset they get... I guess I'm just curious how you all handle this situation. Thanks!!

[scottaprn]

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.

[_Andvari]

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

[imintrouble, BSN, RN]

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.

[RainMom]

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?

[_Andvari]

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

[calivianya, BSN, RN]

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.

[Karou]

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.

[dudette10, MSN, RN]

No one complains about how fast or slow or by what method we are giving any medication, except for benzos and opiates.

What they don't know or don't care about is that they should be much more concerned with the way cardiac IV drugs or given. *sigh* You could have 20 nurses give them in 20 different ways, and no one would notice.

[Sassy5d]

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

[cardiacfreak, ADN]

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

[dudette10, MSN, RN]

Pts don't remeber the name or doses or frequency of their BP meds, cardiac meds, necessary supplements, or anti coags. But when it comes to their sleeping pills, pain pills, or sedatives, they know the name, dose, and how often they take it. When they are close to discharge, and the route is changed from IV to PO in prep for going home, at least half my pts become upset by the change and request one more dose IV. At this point, I don't give a flying fig, so I ask for a one-time dose to make my job easier, and that's exactly what I say to the prescribing resident.

in my short career, I have learned that I can't care more about a pts well-being than they can care for themselves. It's not a "good fight" I'm gonna win, so I refuse to fight it.