I'm just wondering how you all do your IV pushes. I'm a new nurse and spend a great amount of time doing 2-3 minute pushes for my meds as I have been taught.
I worked with a new nurse today that told me when giving a push through the proximal Y-site with fluids running wide open, she just slams it in because the tubing holds approximately 2 mLs and the pt will get it slowly enough.
I'm wondering how many use one or the other methods. Thoughts?
The extant research demonstrates that doses over 180mg of oral morphine have no increased analgesic effect, only increased ADR.
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I can't find anything that says that. What I can find are along these lines:
G. MAXIMUM DOSE -
There is no absolute maximum dose of opioids for chronic pain due to cancer. Since tolerance develops to respiratory depression (see below), doses can be increased gradually to maximize pain control. As long as patients are getting some relief, and side effects are at an acceptable level, opioid doses can be increased. When patients are getting no relief, or side effects are greater than analgesic effect, opioid doses should not be further increased. Instead, a new drug should be instituted. Patients may display individual variation in analgesic response to the same drug. Such variation cannot be accurately predicted.
It was being managed by our palliative care doctors in conjunction with the palliative care team at the regional major teaching hospital.
As far as I know there is no established dose at which receptor saturation occurs, the only thing we know is that it is highly variable. One way to tell if you've reached maximum efficacy is when additional amounts do not produce any additional effects, and the boluses were still clearly producing an effect both subjectively and objectively.
There are a number, including several texts, but the basic principle is generally accepted as highlighted in the paper below, in the treatment of non-terminal pain. Obviously with terminal pain the game changes as ADRs are not of the same concern.
Ballantyne, J. C., & Mao, J. (2003). Opioid therapy for chronic pain. New England Journal of Medicine, 349(20), 1943-1953.
Chicago
I am far from a palliative care expert, but I did train in inpatient palliative care as an NP. In terminal care it becomes more gut-based than evidence-based. But 8 grams of oral morphine equivalent per hour is a tremendous dose. The LD50 on morphine is about 140mg/kg over 120 minutes in animal studies.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
Wow, I'm an Oncology nurse and have never seen more than 2 or 3mg/hour of IV Dilaudid given, and that is for opiate non-naive patients, and even palliative care only cancers. We might be supplementing with PO Oxy IR or Oxycontin, but giving Dilaudid 400mg/hour, OMG. I would have refused, cause I can't believe anyone could take that much and live.
I'm aware of the manufacturer recommendations for these medications, and we have a great many drug resources available to us at work. (Our eMAR also notes recommended administration times), but my point was not if people knew the recommendations, but if they truly gave it that way every time.
As others have said, most meds come in a variety of strengths and packaging for a variety of uses.
Yup that is what we have as well. Only thing is that we cannot use the prefilled normal saline flushes as it is not compatible to fit onto the B port.
I've used that same pump before. What's really nice about that pump is that you can program that B channel (port) to infuse concurrently with the A channel if need be or you can program it to run in a similar manner as a traditional secondary. With those prefilled 10mL syringes, as I recall (it's been a while) you can put a clave port adapter type device on the B port and that kind of physically raises the attachment point high enough to easily attach stuff, including those 10 mL syringes, to that port. The bigger syringes don't fit as well, though you could use a small extension set to make that happen... and the pump will happily pull from that syringe.
Specializes in ORTHO, TRAUMA, MED-SURG, L&D, POSTPARTUM.
This question is similar to the one posted. In school we learned to push the med for the time stated then push the IV flush for the same push time. A teacher told us that is not how things are done in the real world. She said the patient IV port (not running fluids) holds 2ml so the first 2ml of medication can be simply pushed into the IV line (not necessarily slammed) because it will not enter the bloodstream. Then the flush can be given over the amount of time the drug is recommended to be pushed. Is this an acceptable practice?
Also I've heard that you can push an IV med into a distal port running compatible IV fluids. This in therory dilutes the medication and gives it over a slower potentially safer time period. What concerns me about this method, is depending on the IV fluid rate, how do you know how fast they are exactly getting the medication? With a fast running IV line, could the patient actually be receiving medication too quickly, even in a distal port?
MunoRN, RN
8,058 Posts
I can't find anything that says that. What I can find are along these lines:
PAIN MANAGEMENT IN CANCER PATIENTS