Haldol IV?

[RelleyRN]

I was working on a med surg unit and rec'd an admission through the ED. I was told the patient was alert and oriented. When the patient came to me he was agitated, confused, combative, refusing care, and disoriented. The physician ordered IV haldol 1mg q20. I gave it twice a couple hours apart. When I came in an hour later to give medal, the patient was contracted and not responding to sternal rubs for about 5min, all VS completely normal. Has this ever happened to anyone? The patient was fine, but now that I'm researching I'm seeing several things about Haldol not approved for IV use. I'm a new med surg nurse (background pedi and oncology), but my preceptor and other nurses did not flinch when I mentioned the order. I also noticed the bottle today said for IM use only.

[banana, MD]

This is an excellent point and unfortunately I have heard of more than one story where patients actually died from depression of respirations which was likely the combination of medications administered in the ED and then prn medications administered after being transferred to the mental health unit. Make sure you know what they have received before you pile more on.

Based on the fact that Haldol is usually given with sedating medications (ativan, benadryl, cogentin, etc...), one would logically believe that Haldol is sedating itself. In fact this is not the case and Haldol alone has no sedating or otherwise dangerous qualities to that effect (i.e. respiratory depression).

Though many clinicians are afraid of using IV Haldol, it is relatively safe and especially in this particular patient. Compared to oral or IM routes of administration Haldol carries a much less if not negligible risk of inducing EPS, negating the need to co-administer EPS prophyllaxis with anticholinergics like benadryl or cogentin, something important for this guy whos bradycardic with CHF.

As far as this pt's DDx here, it seems relatively broad, though a thorough hx and motor/neuro exam would probably help shed more light

[canoehead, BSN, RN]

There are two types of Haldol, and one can be given IV, one is labeled "not for IV use" because of the preservatives. At my hospital the pharmacy has given us permission in their policies to administer the "not for IV use" type through the IV. They've explained it all, but it's over my paygrade to judge it a wise or unwise decision. Anyway, there's at least one hospital that gives the "not for IV use" Haldol through the IV.

[imintrouble, BSN, RN]

I've never given it IV. Never even seen it ordered IV. We have to sit on the patient until the IM kicks in.

Look at what I've missed.

[VANurse2010]

We give IV haldol all the time. IF the dose is 5mg or greater or if the patient will get 10mg or more in a 24hour period, hospital policy is the patient must be on tele. (Because of QT segment prolongation issues).

I have found that haldol is worthless most of the time. Not sure how everyone else finds it but We'll give 2mg Haldol x 3 doses (Over 5 to 8 hours) and the patient is still smacking the nurses across the face with the plate covers. (yes that happened to me, nearly broke my nose)

If that's the case, the dose probably wasn't high enough. 5 mg IM/IV is not unheard of.

[calivianya, BSN, RN]

Haldol either doesn't work at all or it totally knocks the patient out in my experience. I have yet to see someone alert and calm after receiving Haldol! I haven't seen any EPS symptoms with its use - maybe I'm just lucky like that. We have to print a strip and calculate the QTc both before and after we give IV Haldol per my hospital's policy.

[Dranger]

2mg haldol IV is nothing and not likely to neuroleptic malignant syndrome or prolonged QT issues unless there are other things in the works

We do 5mg IV all the time

[canigraduate]

When I've given Haldol for agitation, it usually doesn't work at first, then it slows the patient down once it kicks in. I don't know the science behind it, it's just what has happened when I've given it. It's like they burn through the first dose, but it brings them down enough that the 2nd or 3rd works.

I've never had them be alert and oriented after giving it, because they were AMS to begin with. Once the UTI or psych issue is fixed, then you're good to go.

It's amazing what 24 hours of IV abx accomplishes in LOM/Ls.

[applewhitern, BSN, RN]

In some of my previous ICU jobs, we would give 5 mg IV for severe w/d symptoms. Never had a problem with it. My current hospital seems to prefer ativan, which I personally do not like. I have seen more adverse reactions to ativan. I LOVE haldol!

[Jules A, MSN]

Based on the fact that Haldol is usually given with sedating medications (ativan, benadryl, cogentin, etc...), one would logically believe that Haldol is sedating itself. In fact this is not the case and Haldol alone has no sedating or otherwise dangerous qualities to that effect (i.e. respiratory depression).

Though many clinicians are afraid of using IV Haldol, it is relatively safe and especially in this particular patient. Compared to oral or IM routes of administration Haldol carries a much less if not negligible risk of inducing EPS, negating the need to co-administer EPS prophyllaxis with anticholinergics like benadryl or cogentin, something important for this guy whos bradycardic with CHF.

As far as this pt's DDx here, it seems relatively broad, though a thorough hx and motor/neuro exam would probably help shed more light

Just for the record my post was simply meant to be a broad reminder that we need to be aware of what a patient received prior to coming to our unit, not directed specifically at the OP or Haldol in particular.

[vampiregirl, BSN, RN]

In hospice, we use haldol IV on inpatients for symptom management. It works very well on some patients for bothersome hallucinations, agitation and helps to address nausea.