Phenergan IV changes in policy - page 3

Have your hospitals recently changed their policy for IV Phenergan? Just this week I noticed that we now have to try 6.25mg first then 12.5mg, it has to be diluted in 20ml and given over 15 minutes.... Read More

  1. by   celeste7767
    Quote from AliRae
    I know the thread's about phenergan (which we don't use) but I do want to ask about the demerol issue ... We use it all the time. Especially on scoli surgeries ... the kiddos across the board come back with demerol PCAs. What's the issue / danger with demerol? I know sometimes it makes my kids forget to breathe now and again, but I've never had a major issue that can't be controlled with turning down the settings.
    As far as your question regarding demerol, I do know that in high doses or with patients who have decreased renal function, the active metabolite from it, normeperidine, does accumulate and can cause seizures. Demerol is NEVER used for chronic pain or in the terminally ill, because unlike morphine which has no ceiling dose, Demerol can reach toxic levels and cause seizures.
  2. by   RunnerRN
    We now have a "trigger pop up" in the Pyxis/Omnicell (we changed in the last few months and I can never remember which is which) when we try to pull out Phenergan. It reminds us to dilute in at least 20 ml - but we can still give 12.5 mg. There hasn't been a hospital wide announcement or policy change.
    Regarding Demerol...we don't even keep it in the machines anymore. I had a doc order it IM for a pt yesterday, and had to hustle down to pharmacy!
  3. by   meandragonbrett
    Demerol forms a toxic metabolite as mentioned earlier. It has a half-life of 24-48 hours (normal renal function) and can cause dysphoria all the way to convulsions. According to some drug guides, demerol shouldn't be given for more than 48 hours. Morphine Sulfate is a much safer narcotic as it does not produce the toxic metabolite.
  4. by   twinmommy+2
    I didn't realise so many hospitals were doing away with phenergan. At my hospital it seems to be the first choice for many to resolve nausea. Although I have seen more zofran orders written though. Mostly they are written along with phenergan for the people who are having a really tough time getting the nausea under control, we will switch out the two every so many hours.

    I give it so often I stock my med cart every morning with 10cc syringes (one to two fistfulls per day). I havn't had problems from it but I do dilute in 10cc's and give in a running NS line.
  5. by   AtlantaRN
    yep, vesicant; plus super ultra sedating, esp if patient is on a pca of anyform...in fact, phenergan and scopolamine have been removed from our pca orders....just the standard zofran now.

    linda
  6. by   Roy Fokker
    Quote from stevielynn
    We give it all the time usually starting at 12.5 mg and have never had a problem. I've never had anyone complain of it burning either.

    steph
    I dilute it in 10-15 cc of saline and run it using a mini-infuser (over 20-30 mins).

    Never had trouble either...
  7. by   anne74
    We also are starting to dilute Phenergan. And I was told by our educator that 6.25 mg typically has the same effect as 12.5 mg.

    So, physically, how do you guys dilute it? When I've diluted other meds before, they came in a bigger vial and we would squirt saline into the vial using a pre-filled saline flush, shake it, draw it back and then inject it. But Phenergan still comes in those little vials. Do you get a 20 cc syringe or something?

    Also, I heard that you're not supposed to dilute meds using those pre-filled saline flushes. Is that true and if so, why?

    Also, how do you mix it in a bag of saline? Other drugs are usually pre-mixed by our pharmacy, so I don't know how to get it from the vial into the bag or whatever.

    Sorry for the elementary questions - I'm a new nurse.
  8. by   nuangel1
    we haven't changed our policy however we have been advised to dilute each dose of phenergan we start with 12.5 mg iv and may repeat .we also use zofran ,anzimet compazine and reglan it just depends on pt and dr.we do't stock demerol anymore our er docs won't order it.i alsways give phenergan diluted in 10 cc saline and only give thru running iv line.never had a problem.
  9. by   GardenDove
    Quote from anne74
    We also are starting to dilute Phenergan. And I was told by our educator that 6.25 mg typically has the same effect as 12.5 mg.

    So, physically, how do you guys dilute it? When I've diluted other meds before, they came in a bigger vial and we would squirt saline into the vial using a pre-filled saline flush, shake it, draw it back and then inject it. But Phenergan still comes in those little vials. Do you get a 20 cc syringe or something?

    Also, I heard that you're not supposed to dilute meds using those pre-filled saline flushes. Is that true and if so, why?

    Also, how do you mix it in a bag of saline? Other drugs are usually pre-mixed by our pharmacy, so I don't know how to get it from the vial into the bag or whatever.

    Sorry for the elementary questions - I'm a new nurse.
    I hadn't heard about not using prefilled syringes to dilute. Do you have a rationale for that? I've been using them lately because it's faster than drawing up saline. I'll eject unneeded saline and carefully draw up the correct amount of med, such as ativan. I've found that convenient and thought it would be more sterile. I'll just add a needle to draw up the med.

    If you want to add something to a bag of saline, there is a port where you can do that, you just draw up the med and inject the proper dosage into the saline bag, usually a 50 or 100 cc bag. Then put on a medication added label.
  10. by   Roy Fokker
    Quote from GardenDove
    I hadn't heard about not using prefilled syringes to dilute. Do you have a rationale for that? I've been using them lately because it's faster than drawing up saline. I'll eject unneeded saline and carefully draw up the correct amount of med, such as ativan. I've found that convenient and thought it would be more sterile. I'll just add a needle to draw up the med.
    Yep! I do the same thing - our floor carries stock of 10cc flushes (for flushing PICCs) - if I'm doubtful, I use a 15 cc syringe and draw up more saline.

    Except that right after I draw it, I wrap a piece of tape around the syringe and write down what's in the syringe (e.g. Phenergan 25mg)... habit I picked up when I was precepting in the ER.

    I know! I know! Not exactly the safest thing to do - but I believe it's better than an unlabeled, 'who knows what is in this thing and why is it infusing through that there' approach

    Once that's done, snap it into the mini-infuser and let it run through a running IV.
  11. by   jannrn
    I use the pre-filled syringes. I draw up the needed amt of med with the blunt tip (metal, not plastic) type needle and squirt it in the 10 cc syringe with saline in it. sometimes I have to squirt some saline out first to make the med fit. I only do one med at a time to know which med is in the syringe, if I have alot, I'll take the supplies in the room and do them one at a time. the flush syringe I leave in the sealed package to know that it is the flush with no med.

    I was have been told the 20ml vials of saline have preservative in them and it is not good to give large amounts. I'd have to check the label, but that is what I was told. the pre-filled syringes I was told do not have the preservative, so it is better if you are pushing the whole amount or several at a time to use those. However, I have also wondered if administration would prefer me to draw up my own as it would be cheaper.
  12. by   GardenDove
    Quote from Roy Fokker
    Yep! I do the same thing - our floor carries stock of 10cc flushes (for flushing PICCs) - if I'm doubtful, I use a 15 cc syringe and draw up more saline.

    Except that right after I draw it, I wrap a piece of tape around the syringe and write down what's in the syringe (e.g. Phenergan 25mg)... habit I picked up when I was precepting in the ER.

    I know! I know! Not exactly the safest thing to do - but I believe it's better than an unlabeled, 'who knows what is in this thing and why is it infusing through that there' approach

    Once that's done, snap it into the mini-infuser and let it run through a running IV.

    I don't see what's unsafe about it, as long as you label it. We don't have syringe infusers where I work, but I'll attach it to the secondery port and program in 10 cc's volume to go in at 40-60 cc's an hour, and that works fine. Then the empty syringe is there to be used in case the primary line goes dry and needs to be back primed.
  13. by   all4schwa
    we spike a liter bag with a luer lock and draw saline that way, i automatically grab a 12ml and dilute everything.
    we mostly use anzemet, does it cause the same problems?
    and, if phenergan is so irritating to the veins, why can it be given IM?

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