morphine pumps

[rubysasha, BSN]

I'm posting this question here and to several other specialty boards in hopes to find a good answer.

I'm working on a hospice unit for the last 6 months (which I love). In the past I worked in ortho for 4 years. Anytime I experienced a pt on a morphine or dilaudid pump, they were run through either a PICC or port. I have to admit that I haven't had very many pumps in my experience, usually morphine PO or SL route works fine, or they will need IV push morphine every few hrs or prn, but every once in a while I come across a pt with such significant pain that they need a pump.

I have a pt now who needs a pump and does not have a port, the dr wants him to get a PICC line in order to get him the morphine pump he very desperately needs. The pt is willing to go through this, and he's going to do it, but my question is.. why can't a drip be given through a peripheral IV? I understand the IV will need to be changed and could infiltrate etc, and were trying to prevent tons of needlesticks for the pt, but I feel terrible to have a hospice pt go through the entire PICC insertion. I feel dumb asking other nurses I work with because I feel like i'm missing something obvious. Has anyone had any experience using a morphine pump/drip with a peripheral IV? why does it HAVE to be through a PICC or port?

[FLArn]

When possible it is good to have a PICC or Port if the patient has a longer prognosis (weeks to months as opposed to hours to days) so as to minimize the number of venipunctures needed. But it is entirely possible to infuse Morphine via PCA in a peripheral line, it is even possible to get effective relief from a subqu site. I've seen all of the above used effectively.

[KelRN215, BSN, RN]

Patients can be on PCAs through peripheral IVs. I've had this with many post-op patients before. Perhaps the goal is to get this patient home? I don't know about in the adult world but, in pediatrics, we'd never send anyone home with a peripheral IV.

[KelRN215, BSN, RN]

Also, a PICC insertion is not a huge ordeal. With a cooperative adult, it can be done rather quickly and at the bedside.

[toomuchbaloney]

The continuous opiate infusions (morphine) in hospice field patients are largely subcutaneous, in my experience.

[Esme12, ASN, BSN, RN]

multiple thread merged as per the TOS

[CapeCodMermaid, RN]

We run our pumps subcutaneously if the patient doesn't have a port-a-cath. Never had any trouble.

[loriangel14, RN]

I work on a palliative floor and we run our PCAs subcutaneously. I works just fine.

[hospiRN]

We only use subcutaneous as well

[areensee]

Narcotic drips can be given through a peripheral line! The problem is that if it is going to be long term, the IV will need to be changed out according to your hospice policies. Also, IV sites have a way of failing, which would mean the potential of emergent on-call visits to restart the IV. We will more often use a subcutaneous drip, which works quite well. The expense of a PICC is of real concern as well as having to transport the patient to a hospital to have the PICC placed. This may be more traumatic to the patient than the alternatives.

[toomuchbaloney]

Isn't it possible to get PICC lines inserted in the patient home for home bound patients?

[areensee]

Isn't it possible to get PICC lines inserted in the patient home for home bound patients?

Not in our area. PICC's are placed by APRN's or physicians exclusively in a clinical setting. We would have to transport the patient to have it placed. This is one reason why when we admit a patient discharged from the hospital, I will always advocate to have the PICC line left in, if they have one. I would rather have the option of using it and maintaining it really isn't all that difficult.