Lasix in Nebs for Air Hunger?

leslie :-D · Jul 1, 2005

yep, we've used it a couple of times only because the effect is more immediate. but the pt still has to have some sort of chf, pulm edema...in other words, fluid in and/or around the lungs.

the lasix solution can come in either 40 mg/5cc or 10mg/1cc- we've used roxane and mixed it w/a few cc of ns and its' effects have been wonderful. but i must reiterate, it is not a bronchodilator but merely diureses the pt. i've also mixed lasix solution w/albuterol and it's worked even better.

much luck to you.

leslie

aimeee, BSN, RN · Jul 1, 2005

Leslie, is the same Lasix solution used that would normally be used for IM or IV administration?

leslie :-D · Jul 1, 2005

Leslie, is the same Lasix solution used that would normally be used for IM or IV administration?

no aimee....it's an oral solution. we used to go through a special pharmacy for our hospice pts. but i would think that any big pharmacy that you contract with, would carry it. just ask about the lasix oral solution. its' effects are immediate. the medical director would want it mixed w/ns.....i'm the one who proposed mixing it w/the albuterol. so he had me call pharmacy just to ensure it wasn't contraindicated (no it wasn't) and it worked much better than the ns.

leslie

doodlemom · Jul 1, 2005

We've used the IV solution...never tried using the oral.

Long Term Care Columnist / Guide · Jul 1, 2005

Well, dang, I learn something new everyday..........going to have to keep this in mind for the future, as we're starting a small inpatient hospice unit and will be working with this situation a lot. Thanks to all of you!

ShirleyR · Jul 3, 2005

yep, we've used it a couple of times only because the effect is more immediate. but the pt still has to have some sort of chf, pulm edema...in other words, fluid in and/or around the lungs.
the lasix solution can come in either 40 mg/5cc or 10mg/1cc- we've used roxane and mixed it w/a few cc of ns and its' effects have been wonderful. but i must reiterate, it is not a bronchodilator but merely diureses the pt. i've also mixed lasix solution w/albuterol and it's worked even better.
much luck to you.
leslie

How much lasix do you add to a ccouple of cc's of ns? I plan on suggesting this to our Med Dir. We use alot of Morphine hypotabs in our nebs, do you use this also? Thanks for any info......Shirley

doodlemom · Jul 4, 2005

When we've used the sterile IV solution, we used it straight, undiluted. Also, we've always used the IV morphine solution for morphine nebs. I've always thought that you should use sterile solutions to nebulize, but I'm not sure why I thought that...the nebulizer machine is surely not sterile!

leslie :-D · Jul 4, 2005

How much lasix do you add to a ccouple of cc's of ns? I plan on suggesting this to our Med Dir. We use alot of Morphine hypotabs in our nebs, do you use this also? Thanks for any info......Shirley

no we don't use the hypotabs- never even heard of them; just good old fashioned roxanol (20mg/cc) w/3cc ns....it's a quick but powerfully effective treatment.

the lasix we use is 10mg/cc and depending on what the md orders for a dosage added with 2-3 cc of ns. it has never exceeded 40mg of lasix and is usually 20 mg on the nebulizer. it's something we don't use alot as there are alot of se's and contraindications. typically my hospice pts bps are low anyway and lasix is just going to decrease it further, thus the reason for the typically low dosage (10-20mg) via mask. but as i stated, i much prefer to mix it w/a unit of albuterol rather than the ns. some docs have ok'd it-others haven't. but i've seen the effects w/the albuterol but it's a method that's not well-studied and md's know little about it(where i worked anyway). often i would have to have the hospice medical dir. speak w/the pcp's to persuade them. even though the medical director SHOULD supersede the pcp's wishes, that's often not the case, trust me. still plenty of paranoid md's out there that think they will be held liable just for the fact that it's their pt.,even when managed under hospice. and our medical director has always discussed the regimen with the pt's pcp as a professional courteousy. it really does get rather sticky sometimes. often i've done my own research and presented it to the pcp,to help out the medical director who doesn't readily have this info available and i do this to ultimately help the pt get what they need.

leslie

ShirleyR · Jul 4, 2005

no we don't use the hypotabs- never even heard of them; just good old fashioned roxanol (20mg/cc) w/3cc ns....it's a quick but powerfully effective treatment.
the lasix we use is 10mg/cc and depending on what the md orders for a dosage added with 2-3 cc of ns. it has never exceeded 40mg of lasix and is usually 20 mg on the nebulizer. it's something we don't use alot as there are alot of se's and contraindications. typically my hospice pts bps are low anyway and lasix is just going to decrease it further, thus the reason for the typically low dosage (10-20mg) via mask. but as i stated, i much prefer to mix it w/a unit of albuterol rather than the ns. some docs have ok'd it-others haven't. but i've seen the effects w/the albuterol but it's a method that's not well-studied and md's know little about it(where i worked anyway). often i would have to have the hospice medical dir. speak w/the pcp's to persuade them. even though the medical director SHOULD supersede the pcp's wishes, that's often not the case, trust me. still plenty of paranoid md's out there that think they will be held liable just for the fact that it's their pt.,even when managed under hospice. and our medical director has always discussed the regimen with the pt's pcp as a professional courteousy. it really does get rather sticky sometimes. often i've done my own research and presented it to the pcp,to help out the medical director who doesn't readily have this info available and i do this to ultimately help the pt get what they need.
leslie

Thanks for the info. I love to learn things to help out the patients. We use hypotabs (immediate instant release morphine) because it's cheaper, but I most definately have used roxanol with nebs before. I found that with patients in respirtory distress it works miracles. Again, thanks! Happy $th of July!!! :balloons:

katwoman7755 · Jul 14, 2005

I usually would just use a low dose Roxanol sublingual for air hunger....it usually worked better than the neb MSO4...unless of course they were COPD pt's...and sometimes I think that extra humidity helps....also, any narcotic can work for air hunger....I know we had some that felt it had to be morphine...but we had one doc that used dilaudid...and the effect was the same. Didn't really use nebulized lasix....worked well subcu if they were in fluid overload....but just air hunger from resp distress....roxanol still my favorite.

Kathryn RN CHPN

RN4ustat, BSN, RN · Jul 14, 2005

I am interested in any and all information I can get about this subject. We recently admitted a patient with advanced idiopathic pulmonary fibrosis. We've tried nebulized morphine solution on her without a lot of success so very interested in this topic. Thanks in advance for any advice!!