IV question

[dsmom]

So I did my 2 hours search last week and I am confused with what I found on the MAR and what I saw on the IV screen.

ordered: morphine drip in d5w 100 mg 14 days 1 mg/hr

sodium chloride 10 mL INJ IV push

LR 1000 ml @ 75 ml/hr

when I went to the patient room I see that there are only 2 separate bags hanging (d5w and sodium chloride 0.9 500 ML). Now I see 2 rates on the screen, one is 75ml/hr and the other is 1mL/hr. What is going on? how come the sodium chloride is at 75 ml/hr and d5w is at 1 ml/hr (isn't this too slow?)

I am on my first year and I should have investigated more but with 2 hours of assessment and writing down all the info I wasn't paying so much attention while I was writing.

[Rose_Queen, BSN, MSN, RN]

ordered: morphine drip in d5w 100 mg 14 days 1 mg/hr

how come the ....d5w is at 1 ml/hr (isn't this too slow?)

The D5W isn't a fluid on its own- it's the diluent for the morphine drip which should be running at 1mg/hr. Based on the rate, the concentration must be 1mg morphine in 1mL of D5W. This is why it's important to fully read orders and confirm what is hanging as well as the rate.

As for why NS is hanging instead of LR, it's possible that the orders were changed or that someone grabbed an incorrect bag. Again, why orders should be checked against what is hanging and how fast it's going. One of the benefits of EMARs and barcode scanning is catching errors.

The sodium chloride 10mL INJ IV push isn't going to be in a bag- it's a flush syringe.

[meanmaryjean, DNP, RN]

Likely the Morphine drip is Y-ed into the Lactated Ringers. So 1 mL/ hour is being carried by the 75 mL/ hour.

The NS is an intermittent flush for when the site is not being used, or for another capped off site to keep it from clotting off.

[dsmom]

Thank you.

As far as why the NS is hanged instead of LR, I heard one of the nurse mentioned something about not having enough supply (I assume that's the reason.. I couldn't ask because as a student I feel like I have no right to butt in between the RNs conversation) but shouldn't it be entered in the system if they switched it?

Also when documenting for the IV on morphine is it right to say:

100 mL d5w with 100 mg morphine infusing at 1mL/hr or

100mg morphine drip with 100 mL d5w infusing at 1mL/hr?

[nursej22, MSN, RN]

I would document morphine sulfate, IV, 1 mg/hr. The total volume for the shift is documented with intake and output, and the total milligrams of morphine is documented on the MAR, or on a document for continuous IV medication.

[Lev, MSN, RN, NP]

Thank you.

As far as why the NS is hanged instead of LR, I heard one of the nurse mentioned something about not having enough supply (I assume that's the reason.. I couldn't ask because as a student I feel like I have no right to butt in between the RNs conversation) but shouldn't it be entered in the system if they switched it?

Also when documenting for the IV on morphine is it right to say:

100 mL d5w with 100 mg morphine infusing at 1mL/hr or

100mg morphine drip with 100 mL d5w infusing at 1mL/hr?

The reason it wasn't entered in the system is because there wasn't an order for it. Not the best practice, but can't say I haven't seen it (or done it). (For example at my old job: The MD ordered D51/2NS+40kcl and that is a bag which must be mixed by pharmacy. Our store room has D51/2NS+20kcl, so I hung that while waiting for the pharmacy bag to come up). Ok, I understand that is not "as bad." However, good practice in this situation would be to call the MD to change the fluids to NS until more LR comes back in stock. LR and NS are both crystalloid fluids and are good for volume expansion so they do the same basic things. LR is mostly NS but has stuff added to it including dextrose. So if this patient had a hypoglycemic event while on the NS, the nurse could be held liable.

The proper way to document the morphine infusion order is as follows

Morphine Sulfate 100 mg in 100 ml D5W infusing at 1ml/hr. (It is a concentration of 1:1, so the patient is getting 1mg of morphine in 1ml of D5W every hour)

[dsmom]

Thank you so much for the help!! This definitely make much more sense now.

[applesxoranges, BSN, RN]

It's 1 mg/hr. The concentration of the medication is probably 100 mg of morphine in 100 mls. So it would be a 1:1 ratio. So it would be 1 mg/hr = 1 ml/hr. If they put in only 1 mg in 100 mls, then the rate would have to be 100 ml and you would be switching the bag every hour. However, at a 100mg/100 ml (100 mg of morphine in a 100 ml bag), you'd get 1 ml/hr = 1mg/hr

[KelRN215, BSN, RN]

Also when documenting for the IV on morphine is it right to say:

100 mL d5w with 100 mg morphine infusing at 1mL/hr or

100mg morphine drip with 100 mL d5w infusing at 1mL/hr?

Morphine drip at 1 mg/hr.

[PyridiumP]

Thank you.

As far as why the NS is hanged instead of LR, I heard one of the nurse mentioned something about not having enough supply (I assume that's the reason.. I couldn't ask because as a student I feel like I have no right to butt in between the RNs conversation) but shouldn't it be entered in the system if they switched it?

Also when documenting for the IV on morphine is it right to say:

100 mL d5w with 100 mg morphine infusing at 1mL/hr or

100mg morphine drip with 100 mL d5w infusing at 1mL/hr?

Both: you would document the volume of D5W in the I&O, and the 1mg/hr of morphine on the medications.

Describe the bag's contents and drug rate accurately: D5W 100cc with morphine 100mg, 1mg/cc, 1mg/hr

It is also impermissible to substitute a different IV solution without a physician prescription. "Because we're out of it" is not acceptable unless it's a true emergency. It Is likely you misunderstood, but you are correct that it ought to be documented properly if different than prescribed. Good spot.