IV Push Ativan

Updated | Posted
by ILoveHorses RN ADN ILoveHorses RN ADN Member

Specializes in NICU/Telephone Triage. Has 33 years experience.

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Hoping to get some support for my story. Please be kind because this involves the death of my mom. My mom had metastatic breast cancer for 3 years and passed away Apr. 2021. She was in the ICU, then admitted to a med/surg floor that also had hospice patients.  I was so grateful the doctor agreed to admit her instead of sending her home because she was in a lot of pain.  She was receiving IV Morphine. Her Morphine dose started at a low infusion rate. When she started vomiting and having more pain, I asked her nurse if she could have IV Ativan. The nurse agreed and gave her the Ativan by slow push. Immediately my mom fell asleep and was not responding much. I have so many mixed feelings about this. I wanted my  mom to be comfortable but I did not expect the Ativan to make her fall asleep so quickly. But she needed the pain/anxiety relief.

So here is my issue. I worked in he NICU for 25 years and we pushed Ativan many times, slowly of course. I have never worked with adults, except with my mom and dad when they were very ill. The other day I was sharing my story about my mom to another nurse and she said "You don't push Ativan!!" She used to work in the ED. I was shocked and confused.  I told her I have pushed Ativan many times in the NICU and so did my coworkers. I go back and forth between blaming myself for asking for the Ativan, which at first made me feel like I helped to end my mom's life. I know the cancer is what ended her life, but mentally I keep telling myself if we would have held off on the Ativan we could have talked to her longer. But she suffered for many months before she passed. So I am also glad the Ativan helped her comfort level. To all the nurses out there who work with adults: is it WRONG to push IV Ativan?? I just want to get some clarity. Sometimes it feels like she died yesterday. I am tired of beating myself up about Ativan. She knew she was passing, and I made sure she was clear that our goal was to keep her comfortable. thanks for reading. 

ILoveHorses RN ADN

ILoveHorses RN ADN

Specializes in NICU/Telephone Triage. Has 33 years experience. 16 Posts

Thank you. So that dosing information doesn't mention if it is a slow infusion on a pump or a slow push. I guess there isn't much difference. Maybe I am looking too much into this. I was just shocked at how quickly my mom fell asleep. I didn't closely watch the nurse when she pushed it, so I felt like maybe she pushed it too fast? I am just done torturing myself over this. I don't have a clue as to why the former ED nurse said you don't push Ativan. ugh

 

Wuzzie

4,848 Posts

The highlight wasn't mine. Read further down to administration instructions where it clearly shows IV push administration. The nurse you were talking to is an idiot. 

ILoveHorses RN ADN

ILoveHorses RN ADN

Specializes in NICU/Telephone Triage. Has 33 years experience. 16 Posts

1 minute ago, Wuzzie said:

The highlight wasn't mine. Read further down to administration instructions where it clearly shows IV push administration. The nurse you were talking to is an idiot. 

Thank you! I needed to hear that.

 

ILoveHorses RN ADN

ILoveHorses RN ADN

Specializes in NICU/Telephone Triage. Has 33 years experience. 16 Posts

 That article even says Ativan is not FDA approved for IV infusion, so push is recommended. 

RNperdiem

RNperdiem, RN

Has 14 years experience. 4,544 Posts

In ICU, we push all kinds of meds like Ativan, midazolam, hydromorphone, morphine and fentanyl. We are giving these drugs for a specific purpose. In 25 years of doing this, I have rarely had a problem.

In my Dad's final week with cancer, the hospice nurse gave us a bottle of concentrated drops containing ativan that helped my Dad's terminal agitation and gave him a more peaceful exit. 

JKL33

6,328 Posts

49 minutes ago, ILoveHorses RN ADN said:

I wanted my  mom to be comfortable but I did not expect the Ativan to make her fall asleep so quickly. But she needed the pain/anxiety relief.

 

50 minutes ago, ILoveHorses RN ADN said:

I am tired of beating myself up about Ativan. She knew she was passing, and I made sure she was clear that our goal was to keep her comfortable. thanks for reading. 

Please do not beat yourself up any more. You didn't do anything wrong, in fact you did right, even during your grief of saying goodbye.

IV meds do have a relatively quick onset of action. In this case your mother was probably exhausted and also had another med with some sedative effect on board (appropriately). It's okay, nothing wrong happened here, but the pain of your loss is real. Wanting her to have relief is evidence of your love for her, not the opposite.

Very sorry for your loss. It's okay to move through the stages of grief as they come to you, including the stage of acceptance. It doesn't mean you didn't love the person.

((hugs)).

 

Been there,done that, ASN, RN

Has 33 years experience. 6,881 Posts

So sorry for your loss. The Ativan had nothing to do with it. You did a great job. I hope your grief resolves. 

JBMmom, MSN, NP

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 10 years experience. 4 Articles; 2,214 Posts

I am so sorry if you've been carrying around guilt related to this conversation. Clearly this nurse was wrong. I have pushed IV ativan hundreds of times. No matter what, as you pointed out and logically understand, it's the cancer that tragically cut your mother's life short. You were doing your absolute best as a daughter and caregiver. Give yourself grace, hoping that happy memories can bring you peace in difficult times. 

HiddenAngels

HiddenAngels

Has 8 years experience. 556 Posts

Condolences, I'm sorry about your mom.

Yes you can push ativan IV, it helps with withdrawal symptoms in people at risk for DTs or grand mal seizures in RRTs. Those are the times when I've mostly had to push it.

ILoveHorses RN ADN

ILoveHorses RN ADN

Specializes in NICU/Telephone Triage. Has 33 years experience. 16 Posts

3 hours ago, JKL33 said:

 

Please do not beat yourself up any more. You didn't do anything wrong, in fact you did right, even during your grief of saying goodbye.

IV meds do have a relatively quick onset of action. In this case your mother was probably exhausted and also had another med with some sedative effect on board (appropriately). It's okay, nothing wrong happened here, but the pain of your loss is real. Wanting her to have relief is evidence of your love for her, not the opposite.

Very sorry for your loss. It's okay to move through the stages of grief as they come to you, including the stage of acceptance. It doesn't mean you didn't love the person.

((hugs)).

 

Thank you. I remember pushing Ativan in the NICU so my brain started playing tricks on me when this nurse said you don't push Ativan. Yes, I played the role of nurse and daughter at the same time to keep my mom comfortable. I wasn't easy. I am just grateful she didn't suffer at all.