[nursenatalie]

Poor patient I had last night, he has been receiving this dose along with 75 mg of demerol q 4 hours for about a week...his poor veins!!! Do you guys give this much phenergan long term? I had to restart his site and his veins are a mess now with the frequent site changes and administration of this med. Just wondering if you guys did this often?

[VivaLasViejas]

This poor patient is getting Demerol *and* Phenergan in those doses IV??! For *how* long??! OUCH!! For one thing, he needs a central line or PICC for IV therapy if he's going to need it for more than a week or 10 days; for another, he needs another form of pain relief. Please speak with his doctor about changing it.......I'm surprised he has any veins left after a week of this!

[LilgirlRN]

I would put the phenergan in a soluset , piggyback, buretrol or however you want to dilute it.

[meownsmile]

I would think the Dem/Phen should be IM if he is getting it every 4 hours, we would use that as an IM schedule. I would expect the patient to need it every 4 hours if they are getting it IV. The half life of an IV med is shorter than IM therfore the dose isnt going to last the 4 hours. I would ask Dr to either put him on a PCA with a prn dose of zofran or soemthing,, or ask him to change the route. Most IV doses ive seen are either q1 or q2 hours, and are prn. I dont know what kind of surgery/illness this is being given for but some questions need to be asked if he is requiring it that often. Both for the nurses convience and the patients. Its not fair to the patient to have to ask for pain med q4 hours round the clock when we have PCA's available.
Now that i think about it, we rarely give 75 IV and 100mg doses are usually only given as preop after they go to holding, and they sure arent given for a week.

[RN-PA]

I've only seen that order on our med-surg floor for IM Demerol and Phenergan-- NEVER IV. We're not allowed to give any more than Demerol 25 mg IV push on our floor at a time anyway.

[nursenatalie]

This patient had a crushed patella repaired with a muscle flap graft. He weighs about 400 pounds, he will be having a roux en y in three months, so I'll see him again then. Anyway he had been on a morphine PCA and graduated to the demerol. He had some complications with his graft and this was the reason for his extended stay. We have a pain management MD who is usually consulted but this guy obviously fell through the cracks. When I went back to work two nights later he had been discharged so they had eventually weaned him to po meds!

[canoehead]

He graduated from Morphine to Demerol? What about Dilaudid?

Demerol- yuck.

Demerol and Phenergan, you'd almost have to mix them in 100cc and hang them like an antibiotic.

We have great luck with Tylenol 1G Q6H to decrease narcotic needs, or a scheduled antiinflammatory.

[Tweety]

I usually dilute demerol and phenergan with about 10 cc's.

But 50 mg of phenergan is too much to give IV. I don't have a resouce but isn't the max recommended dose for IV only 25?

[barefootlady]

As stated earlier this should be diluted in 100 cc of NSS and given as a PB over hour.
This patient should have a PCA. He should be on a antiinflamatory agent. Most of the ortho doc's here give Toradol IM in the PAC unit and give 2 more doses IM every 8 hours, this help with inflamation.
Why is this guy not getting po pain meds for break through pain. A crushed patella IS painful, seems like a pain management specialist should be called for some input.

[nursenatalie]

Patient was receiving scheduled Toradol...no doubt the inappropriate dosing/drugs used here...dont think 1 gm of Tylenol would help his pain much...dont matter how often or much. If I take orders from a doc for anti-emetic I always discourage them from ordering Phenergan (prefer Zofran, reglan, anzemet) Some docs seem to order it more often defiantly...we have some old school docs around who dont realize Demerol is NOT a good pain med.