IVP vs IVPB

[PediLove2147]

So I was curious and began reading old threads about narcotics being given IVP vs IVPB. I thought I would get some input on my particular situation.

I just started on a surgical unit and a lot of our patients are on IV narcotics, usually Q3 or Q4. The order is just "IV" so no specification on whether is should be IVP or IVPB. My preceptor puts all narcotics in a 50 ml bag of NS and runs it over 30 minutes. She says she doesn't feel comfortable pushing them. We do leave while they are infusing, which is something a lot of people mention as a big no-no. I assume a lot of other nurses do the same (IVPB) because there is usually an empty bag with tubing hanging in the room. We just switch out the new bag for the empty bag. Now, after reading I see that this is not the norm. Most RNs (on here anyway) give narcotics slowly, sometimes diluted IVP.

Should I say something to my preceptor? I don't want to go against her but at the same time I want to be doing what is best for the patient and my license.

Thanks! :)

[wooh, BSN, RN]

I'm going to agree that diluting it in 50 instead of 5 or 10 does NOT need an order. If they're fluid restrict? Well then don't do it. This is up there in "I'm scared to use my judgment instead of being told exactly what to do by the physician" territory with the 10 pages arguing over whether we need an order to flush an IV. Administration is the nurse's domain. Many physicians wouldn't have a clue how fast to give a med or how much it needs to be diluted anyway.

This isn't a choice of lidocaine (a DRUG) or sterile water for rocephin. This is a choice of saline or saline.

I'm not saying I would do as the OP's preceptor with all narcs, but if I had the rare order for IV phenergan? Yep, I'd do it without calling for an order for a few extra ml of saline in a heartbeat.

[sapphire18]

I have never in my life given a pain med via drip as opposed to push other than in the case of end of life care where it is a continuous infusion, or PCA which is technically boluses anyways, not a drip. Both were in LOCKED iv pumps. The MDs were aware of the extra ivf the pts were getting in these instances, too. You can't just as a nurse decide to give the pt an extra 50cc of NS or D5 every 3-4 hours. And I don't agree with the whole "needing an order to flush an iv" thing either, but yet they don't throw flushes on the MARS for the hell of it. I assume this is a jcaho thing, but I could be wrong.

[beckster_01, BSN, RN]

It's really not my style to come off as harsh, but if she has a problem giving narcs, she has no business working in a surgical unit. Really, this is a personal problem of hers that needs to be resolved. Patients should not have to pay for her discomfort with their own. Post op pain can be really severe, especially at first. Those patients need pain relief. There are studies out the wazoo showing that patients whose pain is relieved are more likely to walk postop, do their coughing and deep breathing exercises, etc., thus avoiding adverse outcomes than those whose pain medicine is declined by the patient or withheld by either fearful or judgmental doctors and nurses.

I feel like I spend half my time trying to convince my patients to take their pain meds. Yes, if your incisional pain is preventing you from taking deep breaths and coughing, then you should take your pain medication when it is due. No, you will not become addicted to pain medication when taking it for acute pain.

As for the original topic, I feel that giving narcotics IVP is a more efficient use of resources... both in nursing time and IV tubing/primary set-ups. There have been a few very specific situations in which I felt that giving pain meds IVPB was more appropriate. Both situations were really issues with adequate pain control. One patient was end-of-life, but not officially. I was working the night shift and her IV dose snowed her, yet without it she was in unbearable pain. I hung it IVPB so that it would last longer without sedating her, and in the morning she got a PCA. Another patient was getting 2mg dilaudid q2h, and knew about our "half hour window" so he was pushing it to be q1.5h. I didn't feel comfortable so I hung it IVPB, again following up with the team to come up with a more effective pain management regimen. Not saying that giving narcs IVPB is wrong, just unnecessary.

[Isabelle49]

There's gonna be one panicked stricken nurse if she checks on an IVPB narcotic and finds the bag and tubing gone. Hanging a narcotic IVPB, unsecured in a locked pump, is no different than leaving a syringe full of narcotics sitting in an open area.

I too have never given narcotics IVPB and that includes NICU, PICU, Peds and PACU, except in the case of a PCA pump.