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?

Specializes in pulm/cardiology pcu, surgical onc.

I've never heard of hanging it over 15 minutes if the patient is reporting better relief with this strange set up than perhaps they would benefit from a PCA.

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also... too much room for error? more error if you push it. I've seen nurses just push it in over 1 second. that's why people need narcan. if you're hanging it in a bag it goes in more slowly it's less likely a patient will go into respiratory distress in high doses.

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Specializes in pulm/cardiology pcu, surgical onc.
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.

But think about it intelligently, drug addicts aren't logically thinking for the most part they will get it anyway they can and it's your license in jeopardy.

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Specializes in pulm/cardiology pcu, surgical onc.

Honestly I push dilaudid slowly as it's ordered and I've never put anyone in respiratory distress. I have used my nursing judgment and given less than the ordered dose due to size, loc, and/or age.

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Okay, I'm not going to lose my license if a patient takes a med down from an IV and drinks it. Get a couple years more of experience and you'll learn this.

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
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?

off topic... i walked into a room of a patient who wanted to leave the hospital ama. i left to get the papers and when i returned with the papers, the doc, and the social worker we caught him taking his iv bag and dripping the contents into a styrofoam cup! the iv bag contained vanco!!! i asked him what he was doing and he stated he was trying to figure out what he was getting because he wanted to leave and maybe he could get it some where else by taking the cup and having it "analyzed". i never once thought he was telling the truth and was confused up until i read the responses of the others...

now my guess is that he planned to drink the rest of his dose, administer it some other way, or sell it! don't put anything past patients, especially those with a past drug addiction history... they think they know more about drug administration then they actually do!

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Okay, I'm not going to lose my license if a patient takes a med down from an IV and drinks it. Get a couple years more of experience and you'll learn this.

Maybe you are the one that needs to get more experience when it comes to dealing with handling narcs. You might not lose your license, but you might lose your job for not following facility policy and procedure. Your license could be reprimanded if your patient took down an IV and drank it if you were not following facility policy.

Others have posted how this is a waste of money using a 50ml bag of saline. Others have posted how drug addicts are illogical. That is the truth. They might not get high by drinking a 50ml saline with 4mg dilaudid, but many drug addicts don't know that. Many drug addicts tend to have drug addict friends who would have no problem sucking the dilaudid right out of that IV bag themselves if they could. I have seen nurses administer vicodins to patients just for them to spit them out as soon as the nurse left the room. They then went and sold these pills. I have also seen patients spit vicodins out in order to save them so they could take a larger dose at the same time. The same thing can happen with a 50ml bag of saline with Dilaudid in it.

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Specializes in Addictions, Acute Psychiatry.

if they've had it before and the same dose as before, slam it within the hosp policy or your guidelines and be done. Hospital admissions where the treating diagnosis is not addiction; nurses have no standing to try to treat and control narcs if a patient is in pain. Hanging it in an IV? I'm happy I'm not there!

If I'm in pain, give it to me over a minute or slam it or whatever...who cares?

So they get a high feeling at first; big deal. That's what narcs do!

Hanging it in an iv to avoid a high is an asinine policy. Push it and watch em and if they get a high feeling, you know it's working. Treating addicts is no big deal if you know how to deal with them but it's apparent the label has more power than reasonable treatment. My guess is a place like that is weaning them day one postop if they've got a tolerance. When it comes to pain relief, I don't mess around. If they say they're in pain or an addict that's in pain (addicts have pain, too) then I don't delay, give whatever it takes within the standing and scheduled orders enough to stop their voicing pain. It's soooo easy!

If they need to address their addiction it will be initiated by them when the time is right and that's where I come in. Post acute admission is the time to address their addiction. Controlling narcs like control freaks in a physical acute setting WILL create more anxiety and therefore more pain. They should read the pain control guidelines. Pain is subjective but when they're obviously calmed, they bother me less then on discharge day we can address their plan for addiction treatment and instruct them how to wean down at home before addiction treatment.

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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.

unless you are dealing with a small adult, this is not a large dose of demerol....50 mg is darn near pediatric dose!

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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?

Yes - they will drink it! I've had detox patients that have had to have the Purell hand sanitizer dispenser removed from their room because they will drink it for the alcohol.

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Specializes in onc, M/S, hospice, nursing informatics.
Okay, I'm not going to lose my license if a patient takes a med down from an IV and drinks it. Get a couple years more of experience and you'll learn this.

Okay... trying not to get too ticked off here.

You asked for advice, now you want to argue with everyone who has taken the time to post? Excuse me? It seems that you didn't want advice after all, just someone to back up your idea of what is right.

If I were you, I'd re-think about your policy of mixing with saline and hanging it. Think about this: if your patient IS an addict, perhaps they have syringes with them. They know how to get meds out of an IV bag after you leave the room and push the med themselves. Then you could be in serious trouble because you weren't in the room to observe their reaction.

I would listen to all the experience out here, check with your facility policy, your drug book... whatever.

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This is where a PCA is a good idea. However, if I have to push Dilaudid, I slowly work in 1mg at a time through a running IV. There is a computer in the room, so I keep up on my charting while taking the time to give the meds.

I do work in a SICU, so addict or not, getting hit by a truck or having big abdominal surgery is going to need pain control.

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