wrong route phenergan?

Problem: Promethazine (PHENERGAN) injection is a commonly used product that possesses antihistamine, sedative, anti-motion sickness, and antiemetic effects. The drug is also a known vesicant which is highly caustic to the intima of blood vessels and surrounding tissue. Formulated with phenol, promethazine has a pH between 4 and 5.5. Although deep intramuscular injection into a large muscle is the preferred par-enteral route of administration, product labeling states that the drug may be given by slow IV push, which is how it is typically given in most hospitals. However, due to the frequency of severe, tragic, local injuries after infiltration or inadvertent intra-arterial injection, ISMP recommends that the FDA reexamine the product labeling and consider eliminating the IV route of administration.

Severe tissue damage can occur regardless of the route of parenteral administration, although intravenous and inadvertent intra-arterial or subcutaneous administration results in more significant complications, including: burning, erythema, pain, swelling, severe spasm of vessels, thrombophlebitis, venous thrombosis, phlebitis, nerve damage, paralysis, abscess, tissue necrosis, and gangrene. Sometimes surgical intervention has been required, including fasciotomy, skin graft, and even amputation....

...Safe Practice Recommendations: Along with the manufacturer recommendations, the following strategies should be considered to prevent or minimize tissue damage when giving IV promethazine.

Limit concentration. Since 25 mg/mL is the highest concentration of promethazine that can be given IV, stock only this concentration (not the 50 mg/mL concentration).

Limit the dose. Consider 6.25 to 12.5 mg of promethazine as the starting IV dose, especially for elderly patients. Hospitals have reported that these smaller doses have proven quite effective.

Dilute the drug. Require further dilution of the 25 mg/mL strength to reduce vesicant effects and enable slow administration. For example, dilute the drug in 10 to 20 mL of normal saline if it will be administered via a running IV, or prepare the medication in minibags containing normal saline if there is time for pharmacy to dispense them as needed for individual patients. (Trissel confirms that promethazine is physically compatible when diluted in normal saline, with little or no drug loss in 24 hours at 21 degrees C in the dark, when prepared in glass, PVC, and polyethylene-lined laminated containers [Handbook on Injectable Drugs, 13th edition. ASHP, Bethesda, MD; 2005:1266].) Extravasation can also be recognized more quickly when promethazine is diluted than if the drug is given in a smaller volume.

Use large patent veins. Give the medication only through a large-bore vein (preferably via a central venous access site, but absolutely no hand or wrist veins). Check patency of the access site before administration. Note: according to the package insert, aspiration of dark blood does not preclude intra-arterial placement of the needle because blood can become discolored upon contact with promethazine. Use of syringes with rigid plungers or small bore needles might obscure typical arterial backflow if this is relied upon alone.

Inject into the furthest port. Administer IV promethazine through a running IV line at the port furthest from the patient’s vein.

Administer slowly. Consider administering IV promethazine over 10-15 minutes. ...

LOVE Phenergan, been giving it IV for 20 yrs, back in the day pts were ordered 25mg IV q4hr ATC X 48 hrs post op. Those were the days, never, ever had IV issues, still give it, usually 12.5 IV in 10cc on secondary, love how it snows 'em, great drug when all else
fails

Needle systems are illegal.....aren't they? I thoguht it was law by now. What compoany tubing are you using, surely then make an adapter.