Has anyone given Haldol IV?

Nurses General Nursing

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I was caring for a very agitated patient the other night. Doctor ordered Haldol 2mg IV. I questioned it as this route is not FDA approved but was told by the pharmacist that this particular form, short acting is given IV frequently across the country. I gave it, no complications arose, but now I question what could have happened if a problem would have happened. Should we give drugs by a route that is not FDA approved? Any input would be greatly appreciated.

Specializes in Critical Care.

That thread is a textbook example of experience trumps book learning.

~faith,

Timothy.

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The Haldol that I administered stated on the vial...for IM use only. The vial did not designate if it was the lactate or deconate type so I had the pharmacist get into the box and pull out the insert and show me which one it was. As far as I'm concerned, if a manufacturer places...For IM use only, that is the way we should administer it. I don't want to hear, oh, it is done all the time. If something happens, it will not be the doctors licence, it will be ours because we were the ones giving it. I have seen doctors order meds by the wrong route and then say....oh, I didn't know it could not be given that way, so I can't always trust a doctor to know...even though we think they should. I trust the pharmacist who knows the intimate details of many of these commonly given meds. I'm just not sure about this situation with IV Haldol from a legal stand point. The hospital did not have a written policy in place regarding this so if something would have happened to the patient as a result of me administering this med, would the hospital have protected me? Thanks for listening fellow nurses.

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Specializes in Critical Care.
The Haldol that I administered stated on the vial...for IM use only. The vial did not designate if it was the lactate or deconate type so I had the pharmacist get into the box and pull out the insert and show me which one it was. As far as I'm concerned, if a manufacturer places...For IM use only, that is the way we should administer it. I don't want to hear, oh, it is done all the time. If something happens, it will not be the doctors licence, it will be ours because we were the ones giving it. I have seen doctors order meds by the wrong route and then say....oh, I didn't know it could not be given that way, so I can't always trust a doctor to know...even though we think they should. I trust the pharmacist who knows the intimate details of many of these commonly given meds. I'm just not sure about this situation with IV Haldol from a legal stand point. The hospital did not have a written policy in place regarding this so if something would have happened to the patient as a result of me administering this med, would the hospital have protected me? Thanks for listening fellow nurses.

I believe that it is lactate unless it's labeled "Haldol Decanoate".

And many resources will tell you that Haldol can be given IV. You can question it, but I don't see how you can refuse the order just because it's an 'off-label' use. We use drugs in 'off-label' ways ALL THE TIME. And this is a well-documented 'off-label' use of this drug.

I know, it's a quandary for a new nurse. It's the kind of thing that experience teaches you. So, your best bet in such circumstances is double-check it w/ the doc, if convenient, the pharmacy, as you did, and certainly, double-check it w/ your charge and document as much. That certifies that you are trying to act as a 'prudent' nurse in the situation, utilizing resources with 'experience'.

And, my old fallback advice to new nurses: NEVER give more than 2 of anything (vials, pills, etc.) without double checking it with your charge.

OH, btw, written policies have 'holes' in them all the time. One of your jobs is to bring such 'holes' to the attn of those that can change them. I would bring it to the attn of your manager and ask to forward to pharmacy and risk management that there is no policy clarification on Haldol IV. That also will protect you.

~faith,

Timothy.

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Specializes in ICU, psych, corrections.

In our unit (ICU), we use Haldol quite frequently (too frequently, in my opinion....too many nurses don't concern themselves with the side effects from Haldol and give it out like candy). The vials we use say "For IM use only" on them. I have questioned pharmacy and was told that is the haldol we give IV? A very common order reads "5mg Haldol Q 1 hour PRN agitation" and believe me, nurses take advantage of that order.

A perfect example of a nurse not taking it seriously was just the other day. We had a difficult patient and he had received prn haldol all day long. When I went to look at his EKG strip, I discovered his QT interval had gone from .36 to .42 over the course of a few hours. I held off on his haldol and over my shift, his QT interval was back to .36-.38.

Melanie = )

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Specializes in Flight, ER, Transport, ICU/Critical Care.

Given IV Haldol without any problems. Do so with some frequency.

Given IV Vistaril without any problems. Do so in rare cases. I know hemolysis is a potential problem, as is injection in site other than vein (artery). Can case loss of distal anatomy. BAD. Other, better drugs out there for IV use. However, for IM use, it is pretty effective in any number of clinical conditions.

One you push a drug, you can't pull it back.;)

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Specializes in Critical Care.
One you push a drug, you can't pull it back.;)

Well, LOL, short of a quick amputation, you can't get it back once it's injected, either. . .

:rotfl:

~faith,

Timothy.

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I don't particularly like haldol as a choice of sedation but if I have to give it I would rather do it IV, at least then it is effective, others routes are like

pis---- in the ocean.

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Specializes in Emergency Department.

I just wanted to add that i have learned so much from reading these posts! As a new nurse, I often feel overwhelmed and want to be sure that I am acting safely. These posts have been a lot of "food for thought" for me. I feel like I am being presented with excellent advice on how to handle those "sticky" situations. Thanks for all your input!

Oh, and that "almost fired today" post was scary! I learned a lot from that one especially!

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Specializes in Hospice, Critical Care.

Yes, we give Haldol IV. And yep, right there on the drug label it says FOR IM USE ONLY. We have called pharmacy several times about it and they always tell us it's OK to give IV. Wish they would change the label but I suppose it's a liability issue. Scary, eh?

Oh, and we're not allowed to have any orders that read "...prn agitation" anymore. State regulations, we're told. The state even told us we can't use standardized sedation scales that contain the word "agitation" in them. How stupid is that?! The PRN reason (preferably physcially) must be specifically written in the order..."Ativan 2mg q2H IV PRN tachypnea ...or tachycardia....or threatening endotracheal tube stability".

I've never given Vistaril IV. Hardly see it used anymore, at least in my ICU.

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Telemetry monitoring should be in use if Haldol is given IV,especially in the elderly. I work on a cardiac floor and if we are giving it IV we call the monitor room and tell them we are starting the push and they monitor the rhythm while the med is infusing for us.

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Specializes in Family Nurse Practitioner.
That thread is a textbook example of experience trumps book learning.

~faith,

Timothy.

I agree.

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