IV Pushes

[NurseMixon]

In the hospital where I work, all of the doctors prescribe IV push Demerol post-op. I have only been a nurse for about a month, but I have found that alot of the patients who I have to give an IV push of Demerol to have their IV sites infiltrate very quickly. Our protocol is to flush with 10cc of NS first, then the Demerol, the flush again with another 10cc of NS. I always push slowly, but the IV seems to go bad anyways:banghead:. Is there something I am doing wrong, or is it common for IV push Demerol to irritate a vein to the point of infiltration? Any feedback is very welcome!!!

[Jolie, BSN]

Your post surprises me for 2 reasons: 1. I thought that Demerol had fallen from favor as an IV pain medication, and for post-op pain due to risk of seizures and other side effects. 2. Back in the "olden days" when it was more commonly used, I don't recall having difficulties with IV sites.

Do other nurses report similar problems? Does pharmacy have any recommendations for diluting and administering IV Demerol?

Perhaps your surgeons and anesthesia care providers would be willing to consider more modern pain relief measures such as PCA.

[GrumpyRN63, ADN, RN]

Your post surprises me for 2 reasons: 1. I thought that Demerol had fallen from favor as an IV pain medication, and for post-op pain due to risk of seizures and other side effects. 2. Back in the "olden days" when it was more commonly used, I don't recall having difficulties with IV sites.

Do other nurses report similar problems? Does pharmacy have any recommendations for diluting and administering IV Demerol?

Perhaps your surgeons and anesthesia care providers would be willing to consider more modern pain relief measures such as PCA.

I agree, demerol went out years ago, in fact, our hospital doesn't even have it stocked anymore, crappy for pain and lowers the seizure threshold, we only use MSO4 or Dilaudid. Back in the day, we had it on PCA about 15-18 years ago and I never had any problems w/ the IV sites

[NurseMixon]

Thanks for the reply. Unfortunately, EVERY patients that comes to us (we are post-op) has an order for IV Demerol, maybe po Percocet if we're lucky, but all of the patients prefer the Demerol. Some of the patients came back with a PCA of Dilaudid (we get a lot of post-op ortho patients) but it is usually DC'd on post-op day 2 or 3 and the Demerol goes into play. I've also had a problem with a patient this week who was getting IV ProCal , Flagyl, and Levaquin. Everytime we (my preceptor and I) would switch him from his antibiotics back to his ProCal it wouldn't be long and he would infiltrate so we eventually had to get an order for a PICC line. Is that common, too? For some reason IVs go bad on me, but I am super careful because they have beat into my head about keeping the IV tubing and site closed/sterile.

[Penelope_Pitstop, BSN, RN]

i routinely gave demoral for post-op tahs, but that's it, and i always gave it through a y-site with a running iv. even if the patient doesn't have a running iv, you could have a mini-bag on a pump waiting for that opportunity.

jess

[iluvivt, BSN, RN]

here is something you may not be aware of...Some drugs no matter how much you dilute with are inherently irritating so in other words dilution does not help at all. Unfortunately, Demerol is on the list so it will chemically irritate the vein and then proceed into an infiltration if not discontinued before that. Also if I remember correctly demerol breaks down into normeperidine which can cause problems in the elderly and others. I think it is toxic to the neuro system..I will have to check it out I think that is way it fell into disfavor