Promethazine IV Question

Paul, I have had an interesting issue regarding IV phenergan. Recently some of the house residents are refusing to order phenergan via IV stating it is not approved for that. The PDR gives the guide lines for IV use . The other evening this came up again so I asked our attending to give me the order for the IV med. when I expressed my frustration over this issue the MD commented "Well, phenergan is not FDA approved for IV use." This was news to me! l.rae RN

news to me too.........

My husband got IV Phenergan recently for N/V during a GI virus. REALLY messed his vein up. IV fluids were finished, so I guess it was given as an afterthought.
By late that evening, he started to experience a lot of localized reaction at the IV insertion site, and all the way up his arm, a path that was clear to me, was the path of the vein. I was ready to take him for immediate follow up of course, but men can me hard-headed sometimes(lol). The inflammatory process subsided after a couple of days, but he still has some distal tenderness.

Now that inapsine is on the "bad"list, our new policy allows phenergan IV only in a lg bore needle and never in a hand vein. Ww do tend to go for the hand a lot in the ED, and most pts have a line before the doc sees them, so we are allowed to mix in 50cc, and hang as a piggyback, even if in a hand. If we give inapsine, they go on a moniter, there is alos one other antiemetic that requires cardiac monitering, but cant seem to remember, I am definatly getting senile! Can anyone help my failing memory?

I've seen the problem with phlebitis when using Phenergan IV. I've also had (and been witness to) events when phenergan IV resulted in over-sedation of a patient... once when administering only 12.5 mg. In this case, we ended up giving narcan to reverse the morphine the patient had also received earlier. Of course, this had it's own ill effects, most notably irritability and severe pain. Even then, the patient was sedated for quite some time.

I find that patients who receive Zofran pre-op have far less incidence of nausea post-operatively. I know I try to avoid giving phenergan whenever possible.

Peace

Our policy was recently changed to having to dilute IV phenergan in 9 cc NS. And like before administering it over at least 1 minute. It amazes me that someone would give it undiluted

I once took care of a young construction worker who had been injected ARTERIALLY in the radial artery (inadvertently) with Phenergan. When I had him, he was on telemetry prior to having his hand amputated! The person who performed the injection was his physician, in his office!

On my floor, (peds) we only last week were ok'd to give phenergan and/or demerol IVP. Prior to that, we always had to give it IM (not too child friendly that way) Inapsine has been moved off the approved list also.
I am definitely going to remember these anecdotes and share them with my co-nurses.
That is just another reason this board is so GREAT!

Hmm......I have given IV phenergan lots of times and have never diluted it. I have looked in several drug books--Nursing 2002 drug handbook and Mosby's 2001 Intravenous Medications handbook and neither one of those texts mention anything about mandatory dilution of the drug. Last hospital I worked at had a policy that stated that IV phenergan could only be given with a running IV. Current hospital I work at has no such policy. They don't even have a Pharmacy IV drug guide--we use the Mosby's 2002 Intavenous meds book.

I always push it slow and follow with a 5cc NS flush.

Like Kaknurse, we have no dilution policy at my hospital either, but since this thread first started I have been diluting it prior to giving it IV and leaving notes in the med kardex for others to do the same. Have had no complaints from pts since starting to do it this way, also copied the comments and took them in for the other nurses to read to enlighten them.