Using Demerol in the ED

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Specializes in Emergency Department.

I was wondering how many of you work in ED's that no longer use Demerol for pain mangement? If you do not use Demerol currently, what happened to take it out of your ED? The reason I am asking is I am currently working in an ED that uses a lot of Demerol for pain. I personally HATE giving the drug--pt's get sick (even when it is given with an anti-emetic), they become verrrry sleepy, etc. We have had more adverse reactions to Demerol in the past few weeks than I can count. I would like to approach our nurse manager and the physician's group about taking it out of our pyxis, but I want to have evidence to back up my request. I have tried searching the net for any scholarly-type articles about the subject, but can't find any. Anybody have any suggestions?

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Specializes in Trauma ICU, Peds ICU.

There's a lot of evidence out their supporting taking meperidine out of circulation.

How did you search for articles? Are you using a basic search engine, or a journal database. Try the latter, because when I researched this a couple of years ago I found no shortage of studies on the ineffectiveness and or excessive risks associated with meperidine. I think I was using Medline and Lexicomp. Let me see if I can find the paper I wrote.

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Specializes in Trauma ICU, Peds ICU.

I think I threw out the report, and I don't have access to a journal database because I'm on my home computer.

See if you're hospital has employee access to a database, that's the easiest way to find this stuff. There is a lot of information out there on this topic.

Here's a recent one I remember reading that was good.

http://journals.lww.com/nursing/Citation/2010/01000/Where_has_all_the_meperidine_gone_.24.aspx

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Specializes in CVICU.

My hospital no longer uses Demerol except in specific cases where it's the specific drug needed - I can't remember if it's for neuros or what. We used to use it all the time for pulling sheaths, but haven't used it in over a year and a half. Too many adverse reactions, and there's plenty of stuff that works better without the SE.

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The hospital that I work at doesn't use it too often because Demerol lowers the seizure threshold.

Positively, Demerol can also affect the thermoregulation of the PT. I've seen it used once for uncontrolled shivering and I think it can control high fevers too.

An extra tidbit, Demerol will not give you pinpoint pupils and the urinary retention that the other narcs will give. This makes it a little more abusable.

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Specializes in psych, addictions, hospice, education.

Many people not-so-affectionately refer to Demerol as "demon-all."

I did informal research for a hospital about demerol several years ago. It wasn't published, but was given to the DON and discussed at required all-nurses' inservices about pain management, as part of what was presented.

I did chart reviews and interviewed current patients. I believe I did about a hundred chart reviews of the charts of patients who had taken demerol, to see if they had reactions. Many, many did....from nausea, to confusion, to sleepiness, to full-body twitching. Coincidentally, at the time I was doing this research, my own son was hospitalized and was one who had the full-body twitches!

As a result of this and some work of other people, that hospital took Demerol off its formulary.

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

we don't have demerol at all in my er.

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Specializes in Trauma/ED.

We have it but I can't remember the last time I used it...

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Specializes in ER.

We don't have demerol in my ER...I graduated a little over a year ago and if I remember correctly I thought no one uses Demerol anymore...don't know why though..

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We don't even have it in our onmicell. We use Dilaudid and Morphine in our ER. The only place I see Demerol in our facility is in the GI Lab, and we use it with Versed for conscious sedation.

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Specializes in Emergency Department/Trauma.

Meperidine was just taken out of our facility also with an auto substitution for Dilaudid.

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Specializes in emergency nursing-ENPC, CATN, CEN.

www.paindr.com/meperidine%20guidelines.rtf

try this--it's a great little article about how the metabolites build up and can lead to neurological issues. now that they have dilaudid, fentanyl-which doesn't seem to have these issues, it is becoming best practice to avoid demerol use and use these other pharmocologicals instead

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