Pushing Dilaudid?

Nurses Medications

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Hello everyone,

I've worked at two hospitals in my career. The first one where I was precepted I was taught to hang dilaudid in a 50cc bag over 15 minutes to avoid giving the pt a high and perhaps snowing them. At this new place I work they all push it. We have a lot of drug seekers that come in, the nurses push (often high doses) of dilaudid, then I'm their nurse and they complain because I hang it. My take is that they are mad because they aren't getting a rush. I am not comfortable pushing, for example 4mg of dilaudid. In my previous experience when hanging it people got effective more long term relief when I hung it. Now I'm questioning it as I want to give the drug appropriately. It says in the drug book that it can be pushed over 2-5 minutes but it says nothing about hanging it. Just out of curiosity, how do you all give IV narcotics?

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We push it where I work. I always push slowly.

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We push it, too. If the patient is frequently needing those kinds of doses, they usually get a PCA pump though. I've actually never seen it hung like you describe.

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We push it and I push it slowly (although probably not over 2 minutes). I don't even think we have 50ml bags of saline on our floor to use for such a purpose. I'd have to order it special from pharmacy and to do that every 2-4 hours would not only be cost-ineffective but time-ineffective as well. I will say too that I really RARELY see 4mg of dilaudid as an order. If they are needing that much pain medicine they would be best served by either a PCA or discharge perhaps ;)

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Specializes in Med/Surg/Onc, LTAC.

One of our doctors literally created an addict where I work, by just changing med orders because the patient 'requested' her 75mg Demerol push q4prn... we all wrote nurses notes on her behavior of NOT having pain, just seeking her fix and he still won't change a thing. She's 'weaned' off her med some to 50mg q 6 scheduled. I've never in my life heard of anyone receiving that amount of Demerol and all of the nurses are having a very difficult time with this. I feel like my license is on the line at times.

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Specializes in AGNP.

Our Dilaudid is all IVP, I have actually never seen it given hung.

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Specializes in Cardiology, PCU, Telemetry.

We always IVP all Dilaudid never have given 4mg at one time. Plus if you give it in 50ml are you in the room the whole time it is being given or are you leaving a narcotic???? That would be a big issue...

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Yes of course I leave the room. I don't see how it would be an issue as it is in a bag so the patient isn't going to take it. It's not like a PCA where there's a huge syringe full of narcotic so we have to lock it. Even if they were to take the bag down what would they do with 50cc of fluids mixed with dilaudid? Drink it?

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Specializes in ICU, Telemetry.

Yup, they will. And I've seen a patient who'd been at the hospital long enough to know how to run our IV pumps turn them on 999cc/hr, thinking they would get high off the NS that was hanging. For my not-in-pain pain patients, I put narcotics in the iv port closest to the IV bag. No instant high as the stuff goes in at the rate of the base line IV fluid.

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Yes of course I leave the room. I don't see how it would be an issue as it is in a bag so the patient isn't going to take it. It's not like a PCA where there's a huge syringe full of narcotic so we have to lock it. Even if they were to take the bag down what would they do with 50cc of fluids mixed with dilaudid? Drink it?

Actually that is a big deal. You are leaving a narc out in the open. What if they empty the bag into a cup and keep it until they have a larger quanity. They can sell this or drink it in order to get a "better" high (some drug addicts are even given themselves enemas with mixtures of saline and narcs). If you don't believe it's been done, I can assure you that it has been. You probably need to check with your pharmacy manager to see what they have to say about it.

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Specializes in ICU, MICU, SICU.

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Lol.. yes they will drink it. I've seen it more than once. I also saw a guy attempt to drip it in his eye when I sat it on the table to open a pill package. I would never.. ever..ever mix dilaudid in a fluid bag. Too much room for error...and too much hassle also. I'm already freakin' busy as it is, lol. Just push it slow, or better yet, mix it with a couple of 10ml flushes and push slowly. :twocents:

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okay- think about this logically. if they drink it they will get a way slower high than if it goes into their IV. that was the comparison I was making. The quickest most absorbant way to get a med is through your vein, not your digestive system or even your bowels.

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