Phenergan?

RedSox33RN · Nov 21, 2004

The best (or worst?) form of torture is Phenergan IVP. I've had it many times in the ER for migraines, and when I was in the hospital for almost 12 days total (over 3 admit times) last December. I was getting Phenergan IVP, and blowing IV's out after every 2nd dose, so was having an new IV started 2-3x a day. Didn't matter how slowed it was pushed or how much they diluted it. My arms were so disgustingly black, blue and swollen for 3 months, that I couldn't wear short-sleeved shirts (not that we DO in New England in the winter, but still). By the end of my stay, I decided being nauseous was better, after BEGGING my doc to change it to IM or suppository. I think it's literally like pouring acid into a vein. It does its job, but at what cost to the pt?

IMustBeCrazy · Nov 21, 2004

Yup, as someone stated before, and as I found out and researched through that very good thread (that a certified infusion nurse posted on) -- all nurses giving IV infusions (including IVP) are held to the standards of the Infusion Nurses Society in a court of law. If you injure someone due to ignorance of these standards, it's your tough luck and it doesn't matter what the most current drug guide says.

My argument at the time is why would a nurse be negligent for a standard that is not taught in school or she never knew existed? However, lawsuits are being won all the time due to lack of knowledge. It was this forum where I first learned of the Infusion Nurses Society and I plan on joining when I am able to do so.

stevierae · Nov 22, 2004

Yup, as someone stated before, and as I found out and researched through that very good thread (that a certified infusion nurse posted on) -- all nurses giving IV infusions (including IVP) are held to the standards of the Infusion Nurses Society in a court of law. If you injure someone due to ignorance of these standards, it's your tough luck and it doesn't matter what the most current drug guide says.
My argument at the time is why would a nurse be negligent for a standard that is not taught in school or she never knew existed? However, lawsuits are being won all the time due to lack of knowledge. It was this forum where I first learned of the Infusion Nurses Society and I plan on joining when I am able to do so.

I am not a certified IV nurse, although I have been starting IVs since the Vietnam era, when I was a Navy ER corpsman. In fact, although I have been an RN since 1981, I never even HEARD of INS until I did home infusion for a brief period in 2000.

That said, live and learn. I know now that anytime any nurse performs an act--she is held accountable to the same standards that the EXPERTS are who perform that act day in and day out. I learned this as a nurse educator and as a legal nurse consultant.

That's a very wise decision, IMustBeCrazy--not just for YOU, but for ANY clinically active nurse, RN OR LVN (LPN) who starts IVs or gives IV medications---to join INS and be constantly informed as to their SOC, guidelines, suggestions and updates. It's quite cheap--I think if you join, for something like $90, you get the INS published standards for FREE--so much cheaper than what my own professional governing body, AORN, charges. We have to join at approximately $250--THEN pay another $100-$150 for the published SOC and guidelines.

Make this your mantra: "Ignorance of the law (or the SOC) is no excuse."

dfryern · Nov 22, 2004

at my hospital we give iv phenergan all the time. our policy is it must be diluted with at least 10 cc of normal saline and pushed very slowly. i've had it before after surgery and with migraines. if it's not pushed slowly it absolutely feels like fire going in. it's also very caustic to the vein, hence our policy of dilution. it works great but it's extremely sedating. i don't believe it's addictive, but it is a heck of a downer and gives you a great nights sleep so i figure that's why people want it sometimes over narcs. personally if i have to get it my mind's in a haze for over 12 hours.

funny, i was wondering the same thing this morning. had a patient who could have had morphine but wanted phenergan instead. go figure! it must be good because i've heard it feels like fire going in and has the ph of around 2.2. goodness knows i wouldn't want that in me.
question for everyone: are you allowed to give it iv push in a peripheral (diluted? undiluted?)? i had heard this was really bad but everyone does it on my unit, and there is no policy on it.

stevierae · Nov 22, 2004

at my hospital we give iv phenergan all the time. our policy is it must be diluted with at least 10 cc of normal saline and pushed very slowly. i've had it before after surgery and with migraines. if it's not pushed slowly it absolutely feels like fire going in. it's also very caustic to the vein, hence our policy of dilution. it works great but it's extremely sedating. i don't believe it's addictive, but it is a heck of a downer and gives you a great nights sleep so i figure that's why people want it sometimes over narcs. personally if i have to get it my mind's in a haze for over 12 hours.

i'll say it again--ph is ph, and dilution has absolutely no effect on ph. you could dilute phenergan in 1000 cc. ns and it wouldn't make a difference--the ph remains the same. if you are going to give it iv, it is better suited to a central line. refer to ins standards or consult your pharmacist.

11:11 · Nov 22, 2004

amputee wins record vermont jury award

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montpelier, vt -- march 15, 2004

a marshfield woman has won a record-setting award of $ 7.4 million in a personal injury lawsuit against a major drug manufacturer.

diana winn levine, of marshfield, filed the product liability suit against wyeth pharmaceuticals after doctors were forced to amputate her right arm in april 2001.

the amputation ended levine's career as a professional guitarist who had performed and taught for more than 30 years.

levine and her lawyers claimed that improper intravenous administration of wyeth's anti-nausea drug, phenergan, forced the removal of the arm.

they claimed wyeth was negligent for failing to properly warn doctors about the drug's potential danger.

last week a washington county jury awarded levine $7.4 million, the largest personal injury award in vermont history.

a wyeth spokesman says the company "is disappointed and will vigorously pursue all appeals."

wyeth claims the drug warnings were adequate and had been approved by federal regulators.

allnurses Guide · Nov 22, 2004

Again, I have to say that this almost sounds like y'all are trying to make me think I'm crazy because I've never ever had the experiences you are all describing with people getting phenergan IV.

I dilute it with 10 cc's of NS and push it and haven't had one complaint. Not one IV blown.

We give it frequently. We also give inapsine, reglan, pepcid, anzamet. Not zofran that I can remember.

steph

Tweety, BSN, RN · Nov 22, 2004

Again, I have to say that this almost sounds like y'all are trying to make me think I'm crazy because I've never ever had the experiences you are all describing with people getting phenergan IV.
steph

Or we can personalize it and say you're trying to say we're crazy because we have.

(I just said you were weird, not crazy. :rotfl: )

I usually ask "does this burn?", so perhaps people won't say anything if they aren't asked or aren't paying attention. Power of suggestion kind of thing makes them say "yeah, you're right, it does a little", but I've also had patients wince in pain as I said before.

redwinggirlie · Nov 22, 2004

It increases the effects of narcotics when used together. In my experience, that's why many patients ask for both.

panda_181 · Nov 22, 2004

Funny...we have a couple of British doctors and they always use Phenergan instead of Gravol...on Maternity I'm talking about. We give it IV push quite often and I have never heard any of them complain about how much it burns. And it's 25mg that we give, undiluted. It is into a running IV though...most of the time...sometimes it's into a loc.

Amanda :)

stevierae · Nov 22, 2004

Again, I have to say that this almost sounds like y'all are trying to make me think I'm crazy because I've never ever had the experiences you are all describing with people getting phenergan IV.
I dilute it with 10 cc's of NS and push it and haven't had one complaint. Not one IV blown.
We give it frequently. We also give inapsine, reglan, pepcid, anzamet. Not zofran that I can remember.
steph

Zofran is outrageously expensive, so that's probably why you don't see it much--we did use it quite a bit at the ORs where I've worked in San francisco.

Now, Inapsine (Droperidol)--I am really surprised to hear that you are still using that. Most of the country has simply stopped using it, due to its apparent cardiac problems (I don't know if these are real or alleged, but due to fear of litigation, it's rarely used anymore.) In fact, I am surprised you are even able to get a supply of it--it's pretty much out of distribution.

It was a good drug, though, while we had a ready supply of it and were unaware of it's cardiac effects.

z's playa · Nov 22, 2004

It increases the effects of narcotics when used together. In my experience, that's why many patients ask for both.

Maybe your pts ask for it together because the narcotics make them nauseaus??????? :uhoh3: