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.

[GeminiTwinRN, BSN]

The only drug I give IM is geodon, and I absolutely love it when it's necessary!

Yep, I'm on the IV side of this one.

Have a great day everyone! :)

[Roy Fokker, BSN, RN]

I prefer IM doses to my pre-op (particularly hip Fx. I usually add 25-50 of Vistaril as well) patients.

Most of my post op ortho patients end up having blocks/epidurals or PCAs so IM is kinda moot at that point.

cheers,

[MrsMommaRN]

see my thinking has been agreeing with most of the posters here, why are they telling me to do im when there is perfectly good iv access? the nurse that is orienting me has been a nurse for 40+ years and its her way or the highway.

[GeminiTwinRN, BSN]

see my thinking has been agreeing with most of the posters here, why are they telling me to do im when there is perfectly good iv access? the nurse that is orienting me has been a nurse for 40+ years and its her way or the highway.

here's what i suggest. while you're orienting, do as she wishes. when you're on your own, do as you wish. (as long as the order is there, lol)

just lay low. she isn't violating any orders. she isn't giving it im without an im order. so i guess this is one of those situations where you learn what you can from your preceptor, and then take that with you what you will.

[leslie :-D]

Here's what I suggest. While you're orienting, do as she wishes. When you're on your own, do as YOU wish. (as long as the order is there, lol)

Just lay low. She isn't violating any orders. She isn't giving it IM without an IM order. So I guess this is one of those situations where you learn what you can from your preceptor, and then take that with you what you will.

i totally agree with this.

you can utilize your own judgement when you're on your own.

leslie

[not now, RN]

We have a doc who orders IM demerol with vistaril for all his post-op cervical laminectomy's (sp?). No IV pain meds the only other option is norco. I dread having to stick them every time they want pain relief. So frustrating.

[GilaRRT]

Why not question her? EBM seems to be the way to prove good medicine. She should be able to back her actions up with good EBM. I suspect the rationale is along the lines of, "thats what I've always done." How do we expect to gain respect as top notch professionals when we use statements like these to justify our interventions?

[melissasrn]

We have a surgeon at our facility that almost always orders pain medication IM instead of IV. Not sure of his rationale, but the patients don't like it. I'd be more comfortable giving a larger dose IM and a smaller one IV. Although it's very time consuming give IV doses every hour or so. Patients requiring frequent dosing should certainly be considered for a PCA, especially on busy Med-Surg units where nurses can easily have 6-8 or more patients each. I think some physicans may order it both ways and leave the route up to the nurse so that they won't be called if the patient loses IV access. JMO, of course.

[ZippyGBR, BSN, 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.

spot on

the only uses for IM as a route

- vaccines

- a few Abx in GUM /STD settings

- if you absolutely can't get an IV ( but equally then there's SC/Oral/IN/SL routes for various meds)

- a very few other situatiosn where it;s more approrpriate e.g. gentamicin 80mg Im when yo have been doing minor urology stuff that needs 'low dose' gent cover

Im morphine in the post op patient is never a good idea unless they are absoutely rock solid from a haemdynamics point of view ( delayed bolus effects if repeated doses are given when someone is even slightly shocked)

[RN28MD]

IM injections should never be given to people in PAIN!!! Just imagine your grandma or mom or dad in the hospital after a hip surgery (which is very painful procedure). Now they are having tons of pain and here you come in with a niddle to cause them more pain. It's just not right.

IV push or PCA should be the 1st choice.

[rita359]

For many years IM was the only easily available route as butterfly iv needles were metal and did not stay in place very long. There was also no such thing as a saline lock with butterfly needles. Now that IV access can be maintained for long periods of time, IM meds are outdated except in those very few meds that cannot be given IV. IV is always my choice and do not understand why a physician would order otherwise.

[MrsMommaRN]

the general consensus i am getting from some of the experienced nurses on the floor is they like to give im rationale being that im will last longer an give better pain relief while not snowing the patient.