Change in IV Phenergan Policy

In 2003 there was a thread, maybe early 2004, about phenergan IV and it was quite lengthy and instructive. I was in my first year nursing school and my teachers had no clue what I was talking about. Since I graduated I've been careful with phenergan, and now look, the facility I'm at has changed their guidelines.

When this came down our NM sent us an email saying we didn't really have to pay attention to the guidelines unless JCAHO surveyors were on the floor, but use our discretion. Hm. Interesting eh?

I like to have fluids going and put in the higher port, slowly. That does seem to lessen irritation down to almost nothing. In CHFers who can't take the fluid, I'll dilute in 10cc syringe with NS and carry one or two extra 10cc flushes with me. Push a few cc of the phenergan solution, push a little flush, back and forth. It can take a few minutes but I really want people to retain their limbs. Plus you can assess and see if it's helping their nausea and so forth.

You know, I don't think it needs to be removed from anyone's formulary; that's kind of a kneejerk reaction. However; it's still manufactured in 25mg vials. If the manufacturer would just make it in 6-12 mg vials instead that'd be nice.

Since I started reading this thread, I have brought the issue of Phenergan IVP to my manager and the staff. My manager talked to the head of OB. I contacted the pharmacy. They did have something written up on it . So now our unit will be giving Phenergan IVP differently and more safe. Thanks for this thread and for all the GREAT threads that everyone posts!!

Our docs always request it piggybacked now in 50 ml ns bags with a slow drip and thats the only way well give it. We had another Er nurse that gave it Im in the deltoid and it necrosed the guys limb she thought she gave it Im but it was more like sub-q.

No policy at my hospital, but almost everybody dilutes 25 mg of Phenergan in 50ml of normal saline and hang it as a piggy back. We don't need an order to do that (hang it as a PB).

Phenergan can only be given through a central venous line and diluted at my facility. It was taken off of our Post anethesia drug order sets. I have seen one episode of severe pain and eventual tissue necrosis when it was given fast into a peripheral hand IV.

Sure wish they'd make Zofran as cheap as phenergan. Presto, no probs.

I think a lot of the issues with IV promethazine is a matter of education. When diluted properly and given in a patent IV, there shouldn't be these issues.

Yeah but you still have way more adverse effects than with ondansetron.

Giving Phenergan in a IVPB 50 cc bag is alot faster than looking for a vein and starting a new IV when the site goes bad.

Side note:
Our formulary requires that orders for Zofran be changed to 4 mg IV Q12 hrs X24 hours. Then, Zofran falls off the MAR and cannot be pulled from the Pyxis. The hospital changed the protocol due to price. This means you can only give Zofran X 2 doses before it is automatically discontinued. That is acceptable for post-op nausea and vomiting, but not too practical for other causes.

wow...I'm really shocked to see all this...I have given phenergan probably a thousand times as an ER nurse (its our most commonly used anti-nausea drug)...I always give it diluted in the highest port, and luckily it has always been ok...I might start doing the whole piggyback thing...I will discuss it with my managers...