"IM doesn't work for me"

TheCommuter, BSN, RN · Mar 15, 2008

Some people are truly addicted to the 'pop' of the needle. IM shots hurt the heck out of them due to hyperalgesia, but they'll poke and prod themselves 50 different times until they can find a vein.

It's not that IM administration doesn't work for this patient. It simply seems that this patient prefers the good 'ole puncture of a vein. At least this is my conjecture.

TX_ICU_RN · Mar 15, 2008

I don't think the IM route is what this patient came in for. Because IM works over time, she does not get that "high" that comes with the IV administration.

StNeotser, ASN, RN · Mar 15, 2008

Without wanting to sound judgemental, what TX ICU RN said.

elkpark · Mar 15, 2008

Without wanting to sound judgemental, what TX ICU RN said.

Ditto ...

Diary/Dairy, RN · Mar 15, 2008

Ditto!

SillyStudent, ASN, RN · Mar 15, 2008

:yeahthat:

nrsang97, BSN, RN · Mar 15, 2008

I have to agree with everyone else.

loricatus · Mar 15, 2008

Let's say you were able to get IV access on that pt. & were to dilute the dilaudid in 50 ml bag and run it in through tubing. I would bet that your patient would have found a way to complain about it because (as most everyone else has said) they are 'seeking' the high that comes from IVP.

I have actually had a couple of these type of patients say that they were allergic to saline, in a manipulative attempt to not have me dilute the narcotic med. I then ask what happens to them when they get saline & follow it with something to the effect of...are you having those symptoms now because you just had 10 cc of saline flushed in after that IV was placed; but, if you wish, I'll just take the IV out and draw up your med for IM because we cannot place an IV if you can't have saline & IM is the only method for those that have saline allergies.

All I can say is that after time, you will start to see a common behavior pattern (related to manipulation) for many drug seekers. With the proper type of questioning, you can usually get them to contradict themselves.

cccnurse · Mar 15, 2008

OK...

Just wanted to get in here before the "righteous" did and start bashing us "bad" ER nurses because we also have the ability to assess BS.

I agree with everybody so far. My experience has been that they don't think they are actually getting what they want if they can't feel the burn. My reply to them in this IM vs IV situation would be that... IM administration of this medication is safer than IV, this is the way it was ordered by the doctor, if you don't want it IM you are refusing treatment and may now leave.

I usually hear some crap about how I am refusing to care for the pt, but I don't bite. I just calmly explain that they had been seen, treated and released by the doctor, this is the treatment he ordered. You have the right to refuse this treatment and may still be on your way.

I've found out that AMA paper work is just as easy to fill out as discharge instructions.

RunnerRN, BSN, RN · Mar 15, 2008

Thanks for the replies so far. Like I said, I've never run across any legit pt who would say that, but I didn't want to judge without hearing opinions of others who weren't involved in the situation. Every cell in my body was screaming "seeker" and she hit all of my top 5 seeker cues....complimented my earrings, addressed me by my first name before I introduced myself, told me where the good veins usually were, stated "I've had people ask me if I'm a IV drug user since I have no veins", and said "I haven't had an IV in months" when she very obviously had multiple new track marks. And on top of that, she did a little commentary as I was vein searching..."she thinks she found one she likes, can she get it to pop at all, reaching for the needle...inserting, inserting, nothing....hee hee hee." So very odd.

crissrn27, RN · Mar 15, 2008

Ok, just for argument sake, I'll tell you my sister's broken ankle story. My sister broke her tib/fib about 2 years ago. I put her in the car, take her to the local ER where I work, they load her up with dilaudid, ativan, and phen. do the x-ray, and send us to an ortho.

When we get to the ortho, he is gone, they closed an hour ago, it was his short day. No splint is on the ankle at this point. Call the doc at the ER, he says come back for a splint. Go back, wait about 5 hours. At this point she is crying in pain, of course we had dropped her prescriptions off, pharmacy said give them a few hours (after begging them not to wait until tomorrow to fill them!).

My sister is a large woman, weighs around 300lb, don't tell her I told you guys. They finally give her IM Demerol and phen. No help. Another IM dose of same, nothing. Total of 20mg morphine, no help. Still crying. Try to do the splint anyway, crazy people, lol. They heard her scream on the 5th floor.

So finally they popped an IV in, gave 2mg dilaudid, she was fine in 5 min. So here is an example of IM not working.

But in your case, I have to say my seeker radar would have been going off, also. My sister wouldn't know a IV street drug if it bit her. This girl sounds like she knew exactly what she was talking about as far as veins were concerned, and there is only a few classes of people that know stuff like that. Nurses, for one, lol, and IV drug users. They are the only people I've ever had make comments like the ones she made.