No More Demerol IV Push???

mandrews · Aug 8, 2005

My teaching hospital is still giving demerol ivp. In fact I gave some Saturday.

I'll have to check on that, thanks!

melissa

fla orange · Aug 8, 2005

The hospital I work at in NC have adopted the same policy. Demerol can only be given IM and the doctor must write the order on a specific pain order sheet documenting why the pt will benefit from taking demerol.

katwoman7755 · Aug 8, 2005

In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.
http://ruralnet.marshall.edu/pain/demerol.htm
http://www.hospicecares.org/Pharmacy%20Newsletter/Spring2002Pharmacy.htm

I read both of the links you provided....I know in hospice we absolutely never used demerol for the reasons that were listed in the article....I don't recall us ever denying payment for Tylenol#3 or DCN, but then again, we never really saw that prescribed either.

It is interesting that changes are possibly being made re: it's use in other medical settings...I know it was always popular in the hospital for short term use. I wonder, though, does giving it IM supposedly decrease these effects (vs. IV)? Doesn't seem like it would.

I know hospice loves MSO4, but you also have to watch closely for neurotoxic effects with it also, esp in the imminently dying patient. I think often times people mistake CNS excitabililty for terminal restlessness.

Always good food for thought.

Kathryn

rjflyn, ASN, RN · Aug 8, 2005

Worked at a teaching hospital for about 2 years, It was all but impossible to give Demerol in any form at all. The reasons for not usinging it were as above but also with the long list of alternative medications the felt there were other options.

Rj:rolleyes:

mommatrauma, RN · Aug 8, 2005

We no longer give it at all, there were studies done that showed poor efficacy, high rate of toxicity, and multiple drug interactions...and there are so many other drugs that have better analgesic properties with less side effects...We have been Demerol free for quite a few years...

Tweety, BSN, RN · Aug 8, 2005

It's no longer our first line of defense in pain relief based on the studies mentioned. However, when a patient has a morphine allery or ineffective pain relief some docs will order it.

Honestly in all my years of giving it IV I never have seen any said side effects, and we used to give it a lot. I have to trust the research however.

jmgrn65, RN · Aug 8, 2005

I think we have stopped giving it also, using diladaud instead in most cases. I believe for the reason above.

VickyRN, MSN, DNP, RN · Aug 8, 2005

Thanks for all the insight and information. :)

New CCU RN · Aug 8, 2005

We don't give it all that often - but we do have it in our narc draw readily available. I'm at a big teaching hospital.

papawjohn · Aug 8, 2005

Hey Y'all

I generally agree with ever-thing above but thought I'd toss in my 2cents worth in.

I don't see Demerol given much now-a-days either and I'm glad. I noticed long ago that Pts got habituated to it much quicker than to Morphine so I looked it up in some of those big fat 'Formulary' books (red covers--you'll remember if you have grey hair) and it was documented there. Something about the peculiarities of the way Demerol worked in the opiate receptor sites in the CNS. It has both "agonist" and "antagonist" properties and--in my simple way--I imagined it 'wearing out' the little dendrite or whatever the neuron might have to slurp up the medicine.

And as a BTW: Whenever I've had surgery (which is the only times I ever needed narcotics) I really really preferred PO pain meds (first) and IM (second) over IV. I could stay awake, move around, that kind of thing. IV narcotics (the few times I got 'em) were a ticket to oblivion and when I woke up I was having pain again. Uncool.

Anybody out there with advanced degree that could straighten me out about agonist/antagonist? It was interesting. Wish I could remember.

Papaw John

caroladybelle, BSN, RN · Aug 8, 2005

In our school's teaching hospital, Demerol can no longer be given IV push (only IM). Is this a new trend? Has anyone heard of this? The rationale is that the metabolic breakdown product of meperidine (normeperidine) is neurotoxic and can cause agitation, irritability, nervousness, tremors, muscle twitching, myoclonus and seizures.

Actually the problem is the Demerol itself, not how it is given.

It has been known for at least 15 years that Demerol has significantly more neurotoxicity risks than other drugs in its' class, no matter how it is given. The powers that be have tried to limit its use, to no avail....MDs still frequently prescribed it out of habit.

Thus responsible facilities have been finding internal ways to discourage its use. If they throw enough roadblocks in the way of prescribing it, MDs will be "encouraged" to change their prescribing habits. Much like facilities that require ID approval for prescribing certain overprescribed antibiotics. Or inappropriately ordering "manual CBCs with diffs" too often....you must provide a reason for its' necessity. Or Lovenox vs Heparin therapy, since Lovenox costs so much more.

My favorite is IV Cerebyx vs. Dilantin. Cerebyx is much safer, much less damaging to veins, can be bolused dosed faster during a seizure, and is compatible with many solutions. IV Dilantin has to be given slower, incompatible with many IV solutions, and there have been lawsuits because of serious damage to veins and tissue during infusion. Yet many nurses are unaware of cerebyx and some hospitals do not carry it.