Mophine IM vs IV

[MrsMommaRN]

i recently started working on a busy orthopedic floor. we often have standing orders for morphine 6mg to 10mg im or iv. what i am finding is a lot of the nurses that have been around awhile like to give it im while the newer set like to give it iv. i'd like to hear what all of you out there think and what your rationale behind giving the drug im vs. iv. thanks in advance for your replies.

[TiffyRN, BSN, PhD]

Many factors; The main reason I would give it IM would be if the order only allows it to be given every 3-4 hrs because the IV dose will wear off much sooner. But there are many factors.

IV advantages: quick onset, less pain (as long as the IV holds), More reliable onset and duration (IM absorption can be uneven)

IM advantages: Possible longer duration of action, poss. less bad effects like resp depression and nausea (but not guaranteed). Don't have to keep IV access (can be tricky for some patients). Don't have to worry about compatibility of whatever is running IV, not usually a factor unless the patient is getting TONS of IV meds and fortunately morphine is compatible with a lot of things.

There is also what you are used to doing; IM injections used to be much more prevalent so some nurses are more comfortable giving it. Also some are restricted by their license; in some areas LPNs/LVNs cannot give IV push meds so they would rather be independent and give the med IM.

Another factor is that some nurses think patients will be less likely to abuse or exhibit drug-seeking behaviors if the med is IM vs. IV. I believe this to be wrong thinking and should not factor into one's decision.

Me, I prefer IV as long as the IV access is there. I don't know if I've "been around a while" or not, 14.5 yrs?

[leslie :-D]

if not giving po/sl, i always give it iv.

im absorption is too unreliable.

many pts need a 2nd im dose after 30 min.

iv administration never lets anyone down.

leslie

[TeresaB930, BSN, RN]

When I was doing my clinicals on ortho, one of my patients was complaining of pain. My clincial instructor happened to be in the room with me, saw that he had Morphine IM PRN ordered and thought it would be a good opportunity to practice an IM injection. We talked to my patients nurse about it, but she stated she would rather give the Morphine IV because its less painful for the patient.

This nurse had been great, showing me many learning experiences and always providing learning opportunities for me. I really developed a new respect for her because she stood up to my clinical instructor, who is highly respected at this hospital, for the well being of her patient.

Anyway, that was my experience with Morphine IM and IV. LOL, probably not helpful, but memorable for me!!

[deeDawntee, RN]

It is IV all the way in my book....

If resp depression and/or length of action is a concern, I will give a smaller dose more frequently, even hourly if need be, or ask for a bolus only PCA.

I think IM is unnecessary, unkind and outdated.

[SassyRedhead]

My daughter was hospitalized this past year, and was given Morphine IV push (over several days) almost q 30 min due to her pain issues. She had an AC IV site. She claims (months later) to have extreme burning sensations in that deltoid area upon very very slight touch. Anyone ever heard of this? Her MD doesn't seem to believe/validate her.

[nservice]

At my hospital, IM injections or pain medications are "Highly discouraged" per Policy. This is a new policy that I updated last month as a member of the pain committee. This is due to unreliable absorption rates with this route. A google search shows that other hospitals are discouraging this route also. Is anyone else seeing this trend?

[GilaRRT]

Why give IM if you have a functional IV? Please, somebody explain this to me. Explain how putting a needle into my a** every hour is superior to a slow IV push.

[Sunflowerinsc, ADN, RN]

At my hospital, IM injections or pain medications are "Highly discouraged" per Policy. This is a new policy that I updated last month as a member of the pain committee. This is due to unreliable absorption rates with this route. A google search shows that other hospitals are discouraging this route also. Is anyone else seeing this trend?

Don' t know when I gave or even saw IM ordered. Takes to long to start acting, poor absorption rates, ect. Also on our medical floor most every one is on DVT prevention procotol so no IM shots. Morphine is nearly always given by PCA or conti infusion or small IV dose q 1-2 hrs. (Another reson to get a pump oder, that q 1-2 hr comes around fast)Also is better for pt to control pain relief and not have to wait for nurse. I beleive when we did give injections years ago it was SQ,not Im for morphine. Pain procotol's call for po, skin patch, sl,or long term IV placement, (PICC,port, ect) way before IM.

[RNperdiem, RN]

In 9 years as a nurse, I have given maybe 2 IM shots in my career. I am more comfortable with IV administration, and in ICU, everyone has IV access. Drugs ordered IM are rare where I work.

[crysobrn]

If there is IV access then go with the IV. I think our docs sometimes write it IM or IV incase we d/c the IV then we can give one more dose of pain meds without starting another IV...

[all4schwa]

it's good to have the order there, so it covers all areas. giving IM when IV is an option is wrong. also, where I work our protocol is that pain meds (no IV or oral) are supposed to be given SC, even if they are written for IM.