Phenergan IV changes in policy

Nurses General Nursing

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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. Now I know why I got in report from the ER that they gave a patient Zofran for nausea. They never use to give Zofran. I looked up some stuff on the internet and I guess Phenergan is a vesicant that can cause loss of limb if injected interarterial. What are the other reasons for the change? If this is true I can see why the policy change, but I am sure a vomiting patient will not like waiting 15 minutes for the Phenergan to be injected.

Critter lover, that edict sounds like it was issued by someone who spends their day behind a desk dissecting data not working at the bedside. It's totally ridiculous. By the time you give the med and throw away the syringe, what does it matter how the syringe was labeled? How idiotic.

Specializes in ICU/PCU/Infusion.

We have been seeing many many more orders for Kytril for nausea where I work than phenergan. The problem is, the patients ask for phenergan by name, and they are convinced that Kytril doesn't make them "feel" the same way. In other words, the euphoria or high isn't experienced by them.

It's a dilemma, that's for sure. I always, always dilute in a 10cc prefilled syringe. I draw up the phenergan with a filtered straw, then attach a needle to squirt it into 9-9 1/2 cc of the saline. Then add the blunt, and off we go.

Also, I'm in the habit of adding the orage label to ANY syringe that has med in it. That way, I have my flush syringe ready to go (blunt already on it) with no label, and the med syringe labeled. If I'm only giving one syringe of med, I don't write what med is in it, the orange label is enough to remind me which is which.

I've never heard of not adding meds to the pre-fills. We use them constantly!

Specializes in Day Surgery/Infusion/ED.
I wish we gave more Zofran. Phenergan is irritating. We have guidelines about diluting with NS that print up on our MARs. However, our pharmacy changes all our doctors Q4-6 hr Zofran orders to Q DAY!!! Something about it being expensive and is really for cancer patients...I can't remember their reasoning. They change it in the doctor's order and write per Executive Medical Committee (or something). Pharmacy also changes every Demerol order to an equivalent Morphine dose (unless they are allergic). The only way around it is if the doc writes "do not substitute". Yep, it ticks the docs off, but most of them are used to it now. Some of our surgeons will only order Phenergan IM.

Zofran is available in generic form. We use it all the time for intra-op and post-op nausea. Initially, it was used primarily for chemo when it first was released, but it can be used for a cariety of indications.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

How about I make a plaster model of the gigantisauric phlebitis in my right forearm? It's as hard as a ROCK and painful as all get out. I tried filming it but no luck. Feel free to come over. Oh did I mention this happened in SEPT 06?

Specializes in Med/surg, ER/ED,rehab ,nursing home.

Giving Phenergan IM can cause tissue and nerve damage in some patients. It is also one of the MOST painful IM shots to receive along with Bentyl. The patient that gets this IM will get those horrible Knots, and lumps on their butts. Even if you give the shot with a Z twist and in the proper location (checking for no blood return). We are now required to dilute Phenergan in at least 10-20 cc and push over 2 min. This really ticks off the drug seeking zombies. I usually ask for Zofran from the docs. Less likely to make my older patients go crazy. Also there is a small population that has an adverse reaction to it. They get tremors, bugs crawling sensations, and all kinds of weird feelings. FYI we are now doing more Toradol especially when the chest pain is due to coughing, or overwork issues.....not cardiac issues. Works wonders. Better relief.

Specializes in Neuro ICU, Neuro/Trauma stepdown.

I found out why I dont see much Zofran where I work, protocol to automatically substitute orders with Anzemet. Cost reasons, I was told.

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