Tylenol IV

cherrybreeze, ADN, RN · Sep 19, 2011

I have seen it come on the scene in the last 3 months. I work in Ortho and a bunch of our surgeons have deemed it "the miracle drug". We typically give 1000 mg Q6 x 24 hours post op- so that puts pts right at their 4G limit for 24 hours.
Also one thing we have learned is that- per our pharmacy, the only IV fluid it is compatible with is normal saline, otherwise it must have its own tubing.
Not so sure I'm convinced of its effectiveness yet, I really think Toradol is the way to go for a non-narcotic pain med.

I remember seeing a memo that came out shortly before I left my last job, that pretty much stated this was how it would be given as well (for the first 24 hours). If not that, then it would be given at the end of the case, so we just would have to be mindful of giving any APAP combination meds.

So, if I understand correctly, you administered a medication you knew nothing about? I do hope you only neglected to write in your post that you spoke with the pharmacy about the drug, how it should be infused, and any side effects you should be alert too, not that you just did it because it was ordered.

It states right in the OP that she spoke to the pharmacy. Also, as far as side effects to be mindful of....it's Tylenol, so it's not an entirely unknown MED, just a new route.

newbienurse2011 · Sep 19, 2011

I work on a floor that receives all the post bariatric patients! They get the Tylenol IV post op. I'm orienting on the floor, and haven't got to hang it myself yet. But all the other nurses say this is a new thing that has just came to be! I'm interested to learn about it!

skipaway · Sep 19, 2011

It is expensive, but great for wee patients, and those who have dysphagia, or who may have had craniofacial diseases/surgery and who can't eat/drink. I reckon it works better than oral paracetamol cos it's fast and efficient.
It's great stuff and the doctors would love to use IV paracetamol all the time, but here they get told off if they do as using it blows the budget.

Our Hospital charges 1000.00 per dose! I'm a CRNA and we've started to use it occasionally as a pre-emptive analgesic. Works well.

blondy2061h, MSN, RN · Sep 19, 2011

Just gave it for the first time last week. Little glass bottle.

xtxrn, ASN, RN · Sep 19, 2011

On a post-op floor would IV Tylenol really be masking temps anymore than the Percocet and Vicoden that these pts are already receiving, both of which contain Tylenol?

Yeah- I understand what you're saying, but the first 24-48 hours, when stronger IV/IM meds are used was the period I was thinking about :)

krimicrat · Sep 19, 2011

The CCU in which I work as an extern has used it for around 6 months or so.

cherrybreeze, ADN, RN · Sep 19, 2011

I have seen it come on the scene in the last 3 months. I work in Ortho and a bunch of our surgeons have deemed it "the miracle drug". We typically give 1000 mg Q6 x 24 hours post op- so that puts pts right at their 4G limit for 24 hours.
Also one thing we have learned is that- per our pharmacy, the only IV fluid it is compatible with is normal saline, otherwise it must have its own tubing.
Not so sure I'm convinced of its effectiveness yet, I really think Toradol is the way to go for a non-narcotic pain med.

Toradol is great; unfortunately, it's also contraindicated in several instances (renal failure, hx of ulcers, hx of abnormal bleeding, age 65 or older). Many patients can't take NSAIDS of any kind for those reasons, so the IV APAP certainly makes a wonderful alternative. Also, a patient could receive BOTH the Toradol and the APAP, which has the potential to reduce the need for narcotic medication even more.

madwife2002, BSN, RN · Sep 19, 2011

I saw it used in the UK on my friend when I was over there visiting about 3-4 yrs ago I was amazed and the RN's said they thought it worked very well

pumpkin455 · Sep 20, 2011

The new MDD of acetaminophen is 3 grams/24hr.

:eek: I did not know that!! Thank you for sharing...I will have to see if our pharmacy is aware!

Phishininau · Sep 20, 2011

Toradol is great; unfortunately, it's also contraindicated in several instances (renal failure, hx of ulcers, hx of abnormal bleeding, age 65 or older). Many patients can't take NSAIDS of any kind for those reasons, so the IV APAP certainly makes a wonderful alternative. Also, a patient could receive BOTH the Toradol and the APAP, which has the potential to reduce the need for narcotic medication even more.

Ketorolac (TORADOL) isn't contraindicated in all of those cases. You should reduce dose from 30mg to 15mg when the pt has elevated renal numbers, or delayed creatinine clearance. It also is not contraindicated in pts with abnormal bleeding any more than aspirin or other NSAIDs are. Perhaps the article that ortho surgeons keep citing as a reason to not give Ketorolac should be read a little closer. One time dosing does not increase bleeding risk appreciably.

In my practice I use ketorolac in almost all ortho and gyn cases. It has a pain relief equivalency of 6-8mg morphine. I reduce the dose with older pts and those w renal compromise. Renal failure I hold it.

Ofirmev is a decent substitute when ketorolac is not used, but it is quite expensive right now.

cherrybreeze, ADN, RN · Sep 20, 2011

Ketorolac (TORADOL) isn't contraindicated in all of those cases. You should reduce dose from 30mg to 15mg when the pt has elevated renal numbers, or delayed creatinine clearance. It also is not contraindicated in pts with abnormal bleeding any more than aspirin or other NSAIDs are. Perhaps the article that ortho surgeons keep citing as a reason to not give Ketorolac should be read a little closer. One time dosing does not increase bleeding risk appreciably.
In my practice I use ketorolac in almost all ortho and gyn cases. It has a pain relief equivalency of 6-8mg morphine. I reduce the dose with older pts and those w renal compromise. Renal failure I hold it.
Ofirmev is a decent substitute when ketorolac is not used, but it is quite expensive right now.

I understand all of that. I can also understand a doc choosing NOT to use it, rather than using a decreased dose, if there is risk present to any degree. I did state that there are patients that can't use ANY type of NSAID for those reasons, not just Toradol.

I don't know what you are referring to when you mention "the article that ortho surgeons keep citing;" I was speaking from my experience (and the info that prints up, from our pharmacists, when any order for ketorolac is entered).

It doesn't just have to be a substitute, the two can be used together. Yes, it's expensive, but that's another risk vs. reward scenario.

Phishininau · Sep 20, 2011

I understand all of that. I can also understand a doc choosing NOT to use it, rather than using a decreased dose, if there is risk present to any degree. I did state that there are patients that can't use ANY type of NSAID for those reasons, not just Toradol.
I don't know what you are referring to when you mention "the article that ortho surgeons keep citing;" I was speaking from my experience (and the info that prints up, from our pharmacists, when any order for ketorolac is entered).
It doesn't just have to be a substitute, the two can be used together. Yes, it's expensive, but that's another risk vs. reward scenario.

I'm aware that ofirmev doesn't have to be a substitute. I was trying to offer an example in that if you want NSAID coverage and you believe the increased bleeding risk mantra with relation to single dose ketorolac. In my practice I use both occasionally, but usually stick to one NSAID.