Most Common IV Push Meds on Med-Surg

[nurseJ88]

Hi there.. I am an orientee on the med-surg floor. Just started.. What are the most commonly ordered IV push meds used on this floor for me to be well-knowledged off? .. consider dilution and compatibility, important things to remember.. I understand that I can look up a med in a drug book when necessary; however, it will really help me to start really knowing the most important ones. Thank you so much. Any IV med book that you recommend?

[clfrn]

I would say Pain - Dilaudid and Morphine, Nausea - Zofran, CHF - Lasix, COPD - Solumedrol, and GERD - Protonix I dilute all my meds with NSS and flush before and after each med. Our hospital requires that you document on the MAR each flush as NSS flush is considered a med. Always stop any IVF before so there is no problem as to compatability. Just remember to push slow as to not loose the site. Know your hospital policy for Mediports and PICC lines and don't take short cuts.

[monty'sma]

I am a member of our hospital based pharmacy committee. I have been an RN since 1975, no comments please. I work on a medical oncology unit and we also have palliative care suites on our unit which is basically like in pt hospice. Recently, I had a physician order Fentanyl IV q2 prn. Though I could not find a current policy, I did recall that long ago we could not give this med unless the patient was monitored. I would like some feedback please.

[Penelope_Pitstop, BSN, RN]

I am a member of our hospital based pharmacy committee. I have been an RN since 1975 no comments please. I work on a medical oncology unit and we also have palliative care suites on our unit which is basically like in pt hospice. Recently, I had a physician order Fentanyl IV q2 prn. Though I could not find a current policy, I did recall that long ago we could not give this med unless the patient was monitored. I would like some feedback please.[/quote']

In my institution, IV Fentanyl can only be given in an ICU, ED, or a setting involving anesthesia like the GI lab, OR or PACU...and yes, those patients are monitored.

However....

if this is a palliative care patient, no interventions are going to be done in the event of any sort dysrhythmia, correct? If so, I don't see the point in monitoring.

My problem with this is the use of Fentanyl vs. Morphine. Did the patient have a Morphine allergy? I didn't think IVP Fentanyl was very useful in a terminal sedation setting. But then again, I only know of IVP Fentanyl from my PACU days, which ended 5 years ago!

[NotReady4PrimeTime, RN]

The reason for monitoring patients receiving IV fentanyl has more to do with chest wall rigidity than it does arrhythmia. In a small but significant number of patients, the muscles of the chest become rigid and the patient is unable to breathe. Laryngospasm may also occur. This would constitute an emergency. I've seen it more than once and it's frightening to say the least.

[Penelope_Pitstop, BSN, RN]

The reason for monitoring patients receiving IV fentanyl has more to do with chest wall rigidity than it does arrhythmia. In a small but significant number of patients, the muscles of the chest become rigid and the patient is unable to breathe. Laryngospasm may also occur. This would constitute an emergency. I've seen it more than once and it's frightening to say the least.

Thanks for the info, Jan. I couldn't actually think of any dysrhythmias associated with Fentanyl, but as I said, my experience with it is practically nil.

But...what would be done if this occurred for a hospice patient? What interventions would be carried out for him or her? Maybe this is a good reason to NOT use this med on palliative patients?

[NotReady4PrimeTime, RN]

Chest wall rigidity and laryngospasm most commonly occur with rapid IV administration, although it's not unheard of with slow IV push administration. The safest route for someone in LTC/palliative care would be transdermally. But if ordered IV, it could be given ver-r-r-r-y slowly, and the administering nurse should be monitoring the patient closely - watching them for any change in respiratory effort. It's such an effective drug that I can't say that it shouldn't be used at all outside of the ICU. Fentanyl patches (Duragesic) are available outside of hospital, at least in Canada. As long as the directions for use are followed to the letter (remove the old one before applying the new one, never cutting the patch, rotating sites, proper disposal for example) it's safe and effective for moderate-to-severe chronic pain.