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?

[steelydanfan]

I would agree with #1 only. If there is indeed any med left in the tubing (?) (studies, please), giving it faster won't help. No med wears off quicker by giving it slower. Be that as it may, just GIVE the drug over a minute or 2, and observe.

[divaRN*]

how is leaving a bag with 4mg dilaudid any different than leaving a morphine gtt? morphine gtts are not locked where i work. only PCAs

[Penelope_Pitstop, BSN, RN]

how is leaving a bag with 4mg dilaudid any different than leaving a morphine gtt? morphine gtts are not locked where i work. only PCAs

I lock mine. I also lock anything like Heparin, Dobutamine, Lasix, etc, or K-Riders.

[morte, LPN, LVN]

I lock mine. I also lock anything like Heparin, Dobutamine, Lasix, etc, or K-Riders.

I am thinking you mean the machine, not access to the med? Patients figure that out, and some fairly quickly.

[fozzyboy]

I am just saying putting the med in a bag of saline and letting it drip in is not an effective way to give dilaudid. I am not saying that the infusion method affects the half life of the med. I am saying they may not get the full dose and dilaudid is a faster acting med.

As for the comment about morophine drips that is an entirely differen drug with different half lifes and metaboli breakdown. Morophin is very appropriate for a drip.

[Penelope_Pitstop, BSN, RN]

I am thinking you mean the machine, not access to the med? Patients figure that out, and some fairly quickly.

Perhaps, but it's better than nothing.

Also, I'm not just locking it from the patient, but from visitors...and DOCTORS!

[canesdukegirl, BSN, RN]

Getting back to the original question, which was posted in November of 2009, I have never seen Dilaudid given via 50ml NaCl bag LEFT IN THE ROOM UNATTENDED. I have only seen and given Dilaudid slow IV push.

[General E. Speaking, RN, RN]

We push.

We have recently developed a pretty aggressive Pain Management policy with standing orders to medicate, change the meds, and dosages. I haven't had a patient on this protocol but it is a step in the right direction.

FYI: this policy encourages IM use of meds if the (first choice) oral meds fail to relieve pain.

[RescueNinja]

During my summer job as a SN on a general surgery floor, we had one VERY FF who is one of the worst addicts I've ever cared for (hate to judge like that, but unfortunately it's true in this case).

Anyway, we used syringe pumps on the floor as only ICU/ER nurses can push in this facility. Pt rang for a PRN and the nurse I was buddied with that day hung the PRN Dilaudid (2 mg diluted to 10 mL if I remember correctly) in the pump and left it there, but didn't turn the pump on as pt had since fallen asleep. Sure enough about 20 min later pt was asking for a wheelchair so her BF could take her out for a smoke. I noticed the syringe was empty and told the RN I was with who asked the pt where it had gone and pt said oh the infusion was done so I turned the pump off because it was beeping. RN said no, you pushed it because I didn't turn it on. Obviously the pt didn't admit to it. I guess it could have been the BF, but somehow it was pushed. Her VS were crazy afterward.

Oops...didn't notice this was an old thread. Sorry!

[anonymurse]

Just out of curiosity, how do you all give IV narcotics?

Exactly as ordered, that's how.

[Super_RN, BSN, RN]

OP:

We push our meds. Some nurses don't dilute it, I do. Burns less and it's easier to push more slowly if it's diluted.

FWIW, I've only administered Morphine gtts (in reference to narcotic gtts), but that was on post-op surgeries who was intubated...so it was partially for pain, partially for sedation.

[General E. Speaking, RN, RN]

Also agree with not leaving a narc hanging unattended with a patient.

Routinely happens. Had a patient this weekend on the following gtts: Versed, Fentanyl and Propofol. No locking device in place. While I am in the room frequently, these meds frequently infuse "unattended" while I am in my other patient's room, getting meds from the pyxis, on the phone with the docs, eating lunch, using the restroom, etc...