Pain meds IV push

[krista312]

Hi all,

i just started at a new hospital and am still on orientation there I came from a smaller suburban hospital where for people in acute pain such as post op pain iv pain meds would be pushed as long as it was in accordance with hospital policy the other day at the new hospital I am training at I had a pt who was sp TLIF procedure in excruciating pain so after checking the hospitals policy for iv morphine I pushed the med into the pt's iv a bit later the nurse who was orienting me that day asked how I gave the morphine and insisted that they was its done there is to put it in a 50ml bag of NS or D5W and hang IVPB to me it seems silly! I'm wondering what your practices/ policies are in other facilities ?????

thanks!!

[ckh23, BSN, RN]

Extremely silly. IV push. Perhaps you should refer your preceptor to the hospital policy.

[StrwbryblndRN]

We push it. We dilute it w/10cc ns and push, or push it through iv fluids, or both.

If unsure how the pt may react, push it slowly. It avoids the rush.

I can see where hanging a 50cc bag may help but seems unnecessary to me.

[merlee]

How does the order read? Does it say IV? IVP? IVPB? Refer to the order and the policy manual.

[Esme12, ASN, BSN, RN]

Hi all,

i just started at a new hospital and am still on orientation there I came from a smaller suburban hospital where for people in acute pain such as post op pain iv pain meds would be pushed as long as it was in accordance with hospital policy the other day at the new hospital I am training at I had a pt who wasp TLIF procedure in excruciating pain so after checking the hospitals policy for iv morphine I pushed the med into the pt's iv a bit later the nurse who was orienting me that day asked how I gave the morphine and insisted that they was its done there is to put it in a 50ml bag of NS or D5W and hang IVPB to me it seems silly! I'm wondering what your practices/ policies are in other facilities ?????

thanks!![/quote

Whether or not it's silly....you need to follow your facilities policy and procedure to protect yourself, your license and your position. Policies will vary from facility to facility, floor to floor, critical care area to critical care area and state to state. Policies are decided upon by standards of care and the personal philosophies and experiences in the particular, that make the facility require dilution. If that's the way it's done, that's the way you must do it if it's policy......and to get along with your co-worker at least while you are on orientation. When you are on your own.......follow policy and do your own thing....

I know that on some really busy nights in the ED I would dilute meds in 50 cc's and hang them piggy back because I didn't have time to stand there for a minute or two.....of course it would never be the first dose that I would hang and walk away from...but it helped me gain valuable minutes on a busy night.

[anniv91106]

Looks like the time taken to get and mix would be just as much as standing there etc.- Putting it in IVPB vs. IVP would mean an LPN could give the morphine...

[ChristineN, BSN, RN]

The only reason I've ever given narcotics in 50cc piggyback is if the pt was a known drug abuser/drug seeker. Otherwise I dilute in 10cc of NS and push it.

[dudette10, MSN, RN]

As long as you are within policy, you can do it by IVP when you're on your own.

If you're with a preceptor and not currently counted in staffing, I'd go with what your preceptor said. It just makes things easier, imo.

We had a conversation about the way to do something at work yesterday. There is no policy to govern it. Most people believed that one of the nurses was doing it "wrong" (not really wrong, per se, just unnecessary...), and they were poking fun at her. I kept my mouth shut. What does EBP say? That the nurse they were poking fun at is right.

[PediNurse3]

When I worked in adult ER, pain medication was given IV push, and it was really nurse discretion if it was diluted in NS or not and how quickly they wanted to give it. In the PICU, depending on the situation and the age of the child, it was given on a syringe pump. I have never put pain medication into a 50 ml bag of NS.

[TrafalgarRN]

Mhhh....never heard of such method of administering Morphine or any other narcotics intravenously but as someone stated you are always covered by following the hospitals policy.I have seen many ways people administer IV narcotics but as a rule its prudent to push IV narcotics for 2-3 minutes.All my IV narcotics are diluted with 10 ml NS and pushed slowly. Some people don't dilute and will use a Carpuject and push the med and then flush. .

So when you hang a 50ml bag whats the infusion rate? And is it safe to leave the patient with the bag infusing while you do other things before reassessment? Personally i would rather wait for those 3 minutes than hang a bag.

[Isabelle49]

I'm not sure it is appropriate to leave a 50cc bag containing Morphine freely hanging. A PCA pump would make more sense, since the freely hanging bag or Morphine is in no one's control and controlled substances are given that name for a reason. Personally, I would refuse to hang a bag containing a controlled substance regardless of the facility policy. The BON may have an opinion on this practice.

[Esme12, ASN, BSN, RN]

I'm not sure it is appropriate to leave a 50cc bag containing Morphine freely hanging. A PCA pump would make more sense, since the freely hanging bag or Morphine is in no one's control and controlled substances are given that name for a reason. Personally, I would refuse to hang a bag containing a controlled substance regardless of the facility policy. The BON may have an opinion on this practice.

First, the OP didn't say it was hung freely. The BON has less say than the DEA. I have done this with many meds depending in the circumstance. Separated by a curtain and having to start another IV on the patient next door 3 mg of morphine run in over 2 mins is perfectly acceptable. Not all morphine is on PCA pumps......they are on regular pumps but not "locked" PCA pumps. There are morphine gtts for hospice and other settings in a critical care area that are not on 'PCA" pumps and are on regular IV pumps.....although in this day and age it would be foolish not to.

As I have stated....one MUST always follow the facilities policy and procedure and if you remain uncomfortable check with the nursing board who usually is concerned with not only how or who may give a med but if there is an untoward outcome. The DEA cares about missing drugs....OP check with your pharmacy, manager and clinical educator about their policy and procedure.