Pushing Dilaudid?

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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?

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 ;)

you should work where i do because doctors are constantly writing Give Dilaudid I.V. PUSH 2-4MG EVERY 2 HOURS PRN

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Specializes in ICU.

Whats so wrong with pushing the Dilaudid? What you can do is, set it up, start pushing it a little,, then take care of other stuff with the patient, , like a small reassessment, or give them a tissue.. then push a little more,, You can incorporate pushing the IV with other tasks that you need to get done in this room, as long as you don't step too far away from their arm. Depending on whether this is someone you think MIGHT grab the syringe and push really fast (these people are rare).. Most people will lay there and let you push it in slowly and you're getting other tasks done,, great time management.

Forget the bag,, unless it is ordered or it is facility policy and pharmacy sent it to you in a bag.

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Specializes in Geriatrics.

I've been given dilaudid many times due to frequent kidney stones and have never had a nurse hang it. In fact if she would i would question her/him and probably be considered a drug seeker. When i am passing a kidney stone i want the pain stopped NOW, not because i am a drug seeker but because i want the pain to STOP! Make sure to take a good look at the patient in question and please don't assume they are drug seekers. I was accused of being a drug seeker for MANY years by a Dr at my local hospital, she would actually refuse to treat me. I had suffered severe migraines for 18 years. Found out last year I actually had a birth defect that was causing the pain and ended up having brain surgery. I later saw the Dr that had repeatadly called me a drug seeker (in front of my kids too) and told her my story.... her reply...."So what." Now please don't take this post the wrong way. I am a nurse and i do know that drug seekers are out there and this is mostly what is being talked about, but unless you actually KNOW for a FACT please don't assume. Everyone handles pain differently. Please no bashing about my post, i usually avoid posting on these topics for that reason, but i'm bored tonight!! PLUS i am pretty much migraine FREE!! Just get about 1 a month now instead of 5 a week!! AND NO DRUGS NEEDED!!! WOOHOO!!:yeah: Happy Nursing ALL!!:redbeathe

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Specializes in Addictions, Acute Psychiatry.

studies show "drug seekers" are not always addicts; some portray addict like behavior only because their pain is not relieved. This study was also extended to "doctor shopping" and they found some were just in pain wanting to get out of pain. I leave the assumptions aside and push whatever is order to be pushed, hang whatever is supposed to be hanged.

Hopefully the doc has educated themselves on pain control and addictive behavior. I will not label a patient as "an addict" or "drug seeking" because anyone would seek drugs if in pain.

Pushing narcs is no big deal if you're experienced doing so. If they've had the amount before, I push it faster since I know that will help their pain, make them feel better and give me more time to deal with others if the patient is feeling better.

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Specializes in Cardiac Telemetry, ED.
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?

I push it.

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Specializes in Certified Med/Surg tele, and other stuff.

I dilute my dilaudid in 10 cc of ns and do slow push. After 20 some years of nursing, I have never had anyone go into arrest. My motto is once pushed you can't get it back, so do it slowly.

As for hanging, all the above mentioned problems came to mind for me. The excess fluid, time constraints and most importantly leaving it alone.

Addicts will drink anything. I had a pt drink his listerine once, trying to get a high!

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I think the advice given here was quite sound. Read the MD orders and follow them to the letter and you'll have no problems.

As far as pushing narcs, it's simple, push it slow, dilute it with a small amount of NS to protect the vein especially if it's a corrosive agent. Pushing over several minutes will allow you to watch the pt and give a good result for pain relief.

I seriously don't get it when you have orders from the MD and some nurses take it upon themselves to diagnose a pt as a drug seeker just because they are in pain and want to be out of pain. I personally try to give patients the benefit of the doubt because it's my job to help them. It's not my job to diagnose them with a drug issue. If I think they do have one, I can detail my thoughts or suspicions in the nursing notes and allow the MD to make the decision of what he thinks is going on. It's not the nurses job to be the narc police and decide a patient doesn't need what the doctor has ordered. Just do a good job, be a good nurse and follow protocol. I have watched patients who are in actual pain and suffering because their nurse decided that they didn't need the ordered medication. That is just wrong, and of course isn't the topic here, but I thought I would throw it in. Take care of your patients and follow the Dr's orders. Don't allow your patients to suffer, that's just wrong.

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Specializes in OB, NICU, ER.

I've pushed Diladid before very slowly, I've also hung the med. Always check the med book if you aren't sure

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So, from a naive doctor...

I get a mixed tone from the responses here. Some seem to have no problem giving Dilaudid to a patient with no organic cause for their pain and some seem to dislike doing it but realize that is their job and others will do anything to avoid giving the drug-seeker their buzz while still giving them the drug.

Like all hospitals, we have obvious drug seekers who fake pain and come in every few weeks for their free food, nice TV, and "hospital heroin." The ED docs give in to get them out of the ED, the doc on call does not want to confront the patient and the nurses just do what is ordered. Every 3 hours the call light goes on, they want it pushed fast, they want the Zofran/Phenergan/Benadryl to follow and when the weekend rolls around their pain disappears and they ask to go home. We are getting denials from insurers and Medicare for these patients for lack of medical necessity for the admission and when the hospital gets denials and has to eat the costs eventually they have to start firing staff to cut expenses, and that includes nurses.

Is this a satisfying part of your job? Do you worry about contributing to a drug habit? Is it as rewarding as treating a patient with cancer or someone with true pain after a surgery? Or do you just "do your job" every day and do what you are told, whether it is the right thing to do or not? Would you not be happier not dealing with these patients?

Why the resistance to do the IV drip or PCA? Pharmacologically there is no reason the drug has to be given over 2-3 minutes- it has a half-life of several hours so giving it over 3 minutes or 15 minutes will produce the same analgesic effect.

I'd love some comments.

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Specializes in Peds, PACU, ICU, ER, OB, MED-Surg,.

First, I've pushed Dilaudid. Do it slowly and watch your patient because it can build up and hit them all at once. What I mean q4 three times in a row and now they have decreased respirations.

Dear Doctor,

Do we find it satisfying to take care of people that we feel are drug seeking? I don't find it satisfying but know that it is my job to take care of all patients assigned to me. I try to remember that even drug seeking patients get sick sometimes. Not all pain is physical in nature, we all know this but our hands are tied by doctors, administration, and JCAHO. We follow orders. If the orders are appropriate and do not harm the patient, we have little backing us up. Yes I can refuse to medicate a patient that I feel is not in pain, but then I have to answer to the doctor, administration and JCAHO that feels pain is subjective and that the pain is what the person says it is. It is the doctor by writing these orders who is creating the problem. If you would start writing only comfort care for these patients i.e. heating pad, warm showers, distraction they would not stay long.

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Specializes in Med-Surg/Tele, ER.

"Why the resistance to do the IV drip or PCA?"

um..because Nurses can't order PCA's....Believe me, I wish more of my patients were on PCA's, I think they are great! Not only does the patient feel like they have SOME control over their care, they also know that the med is right there and they can get it anytime without having to wait for the nurse to find some time to do give it to them.

To the OP, I also push the Dilaudid, I always mix in 10cc NS and push slowly, Yeah, I've had people say "why does it take you so much longer than the other nurses" I say "because if I push this too fast, you can stop breathing" That usually shuts them up.

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Specializes in Med-Surg/Tele, ER.

"We are getting denials from insurers and Medicare for these patients for lack of medical necessity for the admission and when the hospital gets denials and has to eat the costs eventually they have to start firing staff to cut expenses, and that includes nurses."

And this is a problem of the MD's, not nurses..we can't admit pts to the hospital, nor can we refuse to admit people..for instance we have ER docs all the time dumping elderly pts on us because they don't know what to do with them. The admitting dx will almost always be UTI even though Medicare will no longer pay for an admitting dx of UTI.

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