Pushing Dilaudid?

[chacmool]

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?

[Reno1978, BSN, RN]

I push my PRN narcs. If they're on a fentanyl drip, I can bolus them from the pump if they need extra pain control. I've never seen narcs mixed in a 50mL bag and hung as a secondary over a long period of time. Waste of resources, IMO.

[Key_]

I've never seen it mixed either. I push slowly over a couple of minutes, but I have also never given more that 1.5mg at a time.

[PostOpPrincess, BSN, RN]

I work in Recovery. We IVP all meds. Don't have time to hang anything but PCA stuff.

And we med with no airway so it's a skill learned in that environment that takes practice, you can push someone into apnea if you're not careful.

[Sillynicunurse]

Does the physician write for it to be given as a drip in the 50ml of saline? If not in my facility they would consider that a med error since I did not follow the order of slow IVP. We push our Dilaudid but we don't usually give that large of a dose.

[MAISY, RN-ER, BSN, RN]

Push it! If you are so worried about respiratory status, age, or snowing them....just do it slow or maybe question what you are giving. You know the drill VS before....15 minutes with reeval after. Although with very old people I have diluted...but usually I will take the 1ml of dilaudid or whatever else and dilute into 10mls normal saline and push slow. Then slow flush.

While there are drugs I throw in a bag like Rocephin on an elderly person or someone with a tiny iv or pepcid....most meds we push if we can....it's more time and money efficient.

Maisy

[Magsulfate, BSN, RN]

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. Drink it. I guess you haven't been around many addicts.

[MedSurgeMess]

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.

Before you go knocking someone else, know that it may be in the facility policy to mix in a bag and hang like this. We can do either or at my facility. I think it's a little naive to think that a druggie would never do that, but I also think it's a little presumptuous to assume every facility policy is exactly the same. Me, I'd slow push it, but to each their own....and while I prefer the PCA route myself, many MDs at my facility won't order them because they say it's a cost issue

[Bug Out, BSN]

Follow the hospital policy, follow the order....the end.

[JRD2002]

If it is ordered as an IVP and you give it in a 50mL bag of NS and administer as an IVPB then that is a med error. Is it one that will cause harm...no...but an error none the less. Also agree with not leaving a narc hanging unattended with a patient.

I also agree that the original poster was not interested in what other people had to say on the subject and only was looking for people to justify their actions...sorry you did not find it...you are wrong...we are right...the end.

[rnmi2004]

What JRD2002 said...if the MD orders Dilaudid IVP & you choose to hang a piggyback, you have changed the route of administration.

You can avoid a high & not change the route. Dilute it in 10mg saline & push it slow, over 5-10 minutes. That way, you are administering the med as ordered, the pain-relief seeking patient is getting treated, and the narc-seeking patient isn't getting a high.

[WalkieTalkie, RN]

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?

This is a bad, bad, bad, idea... would you leave 2 Percocet sitting on your patient's bedside table when anyone from staff to a family member (even a child) could come in and pick it up? If you're giving a pain med, the patient probably knows that's what you've hung as he/she has just requested pain medicine.

I never leave narcotics unsecured anywhere.

...and what about the patients who are getting it every hour or two? If you're continually putting it in 50 ml of saline, the patient could have an extra 600 ml of fluid in one 12 hour shift. In my area of practice, you've just gone half way through their daily fluid restriction!

http://www.umm.edu/altmed/drugs/hydromorphone-065100.htm

"I.V.: For IVP, must be given slowly over 2-3 minutes"

If you're that worried about it, just dilute it in a few mls of saline and put it in a 10 ml syringe on a Bard pump.

[morte, LPN, LVN]

What JRD2002 said...if the MD orders Dilaudid IVP & you choose to hang a piggyback, you have changed the route of administration.

You can avoid a high & not change the route. Dilute it in 10mg saline & push it slow, over 5-10 minutes. That way, you are administering the med as ordered, the pain-relief seeking patient is getting treated, and the narc-seeking patient isn't getting a high.

nope, still IV