Pain meds during dialysis

[Morainey, BSN, RN]

Without going into a million specifics, if a patient was experiencing pain during their dialysis session, would be it be better to give a PO or an IV pain med? I asked several RNs and the pharmacist, and the consensus was that IV will work faster but in general pain meds don't last as long. I was figuring IV meds would get dialyzed out right away. Any good answers for this?

PS I don't normally work with dialysis patients so forgive me if I seem clueless.

[Bruce_Wayne, ASN, RN]

As far as I know, no drug will be effective and administering it before or during dialysis may interfere with your ability to administer immediately after when it would have an affect. Interventions like positioning, quiet environment, and distraction are pretty much the route I think you need to try.

[ked20]

Use a drug eliminated by liver, not kidney.

[Chisca, RN]

Alot of confusion on this subject but my understanding is that dialysis can only remove a drug that is small enough to pass through the dialysis membrane and is not bound to either protein or a receptor site. Most pain medications work on receptor site theory. Any drug that can be removed by dialysis requires numerous passes through the artificial kidney and must be free in the serum. A typical dialysis treatment may pass anywhere between 40 to 60 liters of blood in the time they are on the machine to achieve a 60% reduction in toxins. So some of the drug may be removed but it is not clinically significant. My only limitation as a dialysis nurse with pain medications is can their BP tolerate the pain medication. And if pharmacy has stocked the omnicell today.

[DialysisRN12]

Lol Chisca ain't that the truth. I worked in chronics and now have been in Acutes for 6 mos. I always say medicate because the patient will still get benefit, even if only psychological lol

[traumaRUs, MSN, APRN]

What I do is order pain meds prior to dialysis and give an additional dose halfway thru dialysis.