50 mg of Phenergan IV push!!!!!!!!!

Specialties Med-Surg

Published

Poor patient I had last night, he has been receiving this dose along with 75 mg of demerol q 4 hours for about a week...his poor veins!!!:eek: Do you guys give this much phenergan long term? I had to restart his site and his veins are a mess now with the frequent site changes and administration of this med. Just wondering if you guys did this often?:confused:

Specializes in Emergency.

my research says phenergan 50 IV is for sedation purposes, although it can be given IM 50mg for other purposes. i can't imagine giving that q4 through an IV. poor thing.

zofran is my favorite, seems like it works every time, but i hear it is very expensive.

I agree with the other poster that said to hang the 50mg phenergan in a bag piggyback.

thanks for allowing me to do some research, hope you find your answer,i know i've learned something. xoxo Jen

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Specializes in ER, NICU, NSY and some other stuff.

We NEVER NEVER NEVER give Phenergan IV here. One of the hospitals I worked ER at had a massive lawsuit with a lady who lost 2 fingers, part of her hand and much tissue loss from the forearm. I tooke care of her later as an ER patient also so I know she is not a myth. Seeing the damage that this woman sustained made me understand why Phenergan in an IM only medication.

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Specializes in Surgical.

By graduate I meant that the doc had ordered morphine for a couple days and then Demerol...no other implications~okay?

(btw... I was thinking exactly what you were, Canoehead..."graduated from morphine to demerol" :confused: )

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Specializes in Neuro Critical Care.

nursenatalie...funny that when I worked in NC that was the pain control choice-Demerol and Phenergan. I haven't given Demerol in the 2 years that I have been gone. Thanks for the trip down memory lane!!! Things never change in good ol' NC.

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Specializes in OB, Telephone Triage, Chart Review/Code.

Had a pt with crappy veins who was getting 25 mg Phenergan q 6 hrs. Even diluted, it about killed her with the pain. Anyway, she refused any more and we had to restart the IV because everything else was giving her pain through the IV. Called the MD and he okayed Phenergan supp.

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I'm surprised at how the hospital nracotic protocols differ from place to place.I

know that no more than 50 mg demerol is pushed and if the doctor orders 75 mg iv, its piggybacked. 25 mg seems to be too small a dose to do anything. My 2 cents. :) I'm no nurse yet but that's what my friends tell me and my experience. Anyone have experience with Gravol IV? THAT burns :uhoh3: !!!!!!!!!

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Yikes! That guy needed a PICC in a bad way.

As far as Phenergan goes, it is my favorite antiemetic. (Also love Vistaril and occassionally thorazine) Why, you may ask? The potentiation theory seems to have been debunked recently, but Phenergan is VERY sedating. I have found that 2mg hydromorphone/25 mg promethazine or 20 mg nalbuphine/25 mg promethazine will put someone to sleep real quick, and many of my patients seem to appreciate that. If someone is asleep, they are not feeling pain. So I think it does lessen pain in a sense.

I will occassionally use high dose Phenergan and some brevital sodium in the ER for "conscious sedation" procedures, but generally not as an adjunct to analgesia.

Now on another note... isn't Toradol just a glorious drug? Between using that and Nubain, my orders for controlled substances are probably half of what they would be otherwise.

My mental chart for pain relief is as follows:

Muskuloskeletal: Toradol or Nubain, Morphine for severe fractures.

Visceral: Diluadid

Chest Pain: MS (occassionally Nubain)

Pain with possible hemodynamic instability: Fentanyl

Headache: Toradol or Nubain

I always give Phenergan with Nubain because I have found that it can cause some dysphoria in some patients due to its selective action on kappa opiod receptors. Phenergan pretty much prevents the problem.

Another little side note... I cannot order Schedule II controlled substances, but I can administer them myself under standing orders from the my supervising physician(s).

-James

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Specializes in Surgical.

The only problem I have with Phenergan's sedation quality is that when a patient has a PCA they will be sedated and only awakened when the pain gets intense...making it harder to "get on top" of the pain again...works great, but tears the veins up

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The only problem I have with Phenergan's sedation quality is that when a patient has a PCA they will be sedated and only awakened when the pain gets intense...making it harder to "get on top" of the pain again...works great, but tears the veins up

I definitely understand where you are coming from on that. PCA is designed to administer analgesia in small increments after adequate pain control has been established. Sort of to keep the concentration at a good constant level. Do you usually have orders to administer a bolus if a person has been asleep and wakes up to pain, in order to get them back to therapeutic levels?

We never use a PCA in the ER, so I suppose phenergan works better in that setting.

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In the ED the most demerol ive ever pushed was 100mg.. if i remember the order was originally for 150. This was a repeat order! All i remember was that this lady was unmonitored and in the hall...I double checked with the Doc who is a excellent doc.."If your not comfortable with it just give 100mg"...I titrated that over 10 min....She left with SOME pain relief (Seeker)

As for phenergan 25 is the most i will push...slow and with a running IV, reglan is given reg., zofran occasionaly for CA pts and those that wont stop vomiting ( To exp.for the ED)

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