Promethazine IV Question

There is no policy in my hospital either. Like many of you I learned from personal experience just how badly it can hurt. I had an ulcer last year and was in the hospital for 2 days...had 5 IV's during that time. I've made it my personal crusade to educate other RN's in the ED to dilute Phenergan in at least 10 cc of NS even if you have a running line. We give a lot of Demerol/Phenergan IV, I always give it separately. I give the phenergan first, wait a few minutes and then give the demerol. I've found that I get much less vomiting in response to the demerol that way.

The first time I pushed phenergan, it was undiluted and as I watched, the web of all the vessels proximal to the site turned red like I was putting red dye in. OUCH!!! Sorry!

Dilute with 10cc saline....that stuff burns up veins like wildfire....and according to the patients , feels the same way......

Well, I'm not sure what to think now. I gave my first iv push phenergan just this afternoon. It was given in a central line. The order called for 12.5-25 mg q 6 hours. My drug book indicated to dilute 25-50 mg with 9 cc of saline and to give 25 mg or less/2 mins. The pharmacy instructions on my MAR indicated to dilute the 25 mg and give over 2 mins. Another nurse stated they usually diluted it. I gave the 12.5 mg and with my drug book and the pharmacy instructions as reference I did not dilute this dose and gave over 2 minutes. My pt. had no problems indicated or c/o during or after receiving this.......but, did I really screw this up or what??
Lisa

Always dilute w/9cc's saline where I work. I have often noted confusion in the elderly with this drug. You have to be very careful. Ambien also causes people to flip out at times!
Once when I was a patient in the ER, the nurse pushed phenergan undiluted into my Medlock---I said-hey...stop..dilute that please!! It hurt like hell, and the vein was tender for a few days later. She was irritated w/me, but stopped and diluted the rest of it.

I have been one the recieving end of phenergan IV, and yup....it hurts......and I only got 6.25mg. and it was diluted in 10cc, and given through a running IV, and still felt like my arm was on fire, and did have a phelbitis for a looong time after. But it did stop my postop projectile vomiting So now I ALWAYS dilute it, and give it sllooow, and tell patients that this is gonna hurt...........And I have also seen it make that sweet lol get way weird and sometimes hallucinate or get very confused and disoriented.........Will ask doc for something else for the elders.

Where the heck are you still giving Demerol?
Meperidine has a nasty metabolite, normeperidine, with a looooong half life. It can cause neurotoxicity, especially in the elderly, and it is not reversible with Narcan. And I thought my hospital was behind the times!

We do give demerol, but we try to avoid it.

When ordered, we give it separately from phenergan, as described by Liligirl, above.

We run it as IVPB in 50cc NS.

I've had some terrible experiences with Phenergan. I was in the ER in a local hospital after N&V and diarrhea X 3 days which I later found out was Giardia. Anyway, I received Phenergan IV push undiluted...yes it hurt but that was not my major concern. About 5 minutes after the med was pushed (he pushed it in about 20-30 seconds) I became restless and literally could not stop moving my arms and legs. This continued and I began crying and asking the MD what was wrong. He told me that it would pass, well...It did but it took nearly 8 hours. They discharged me after a liter of fluid and sent me home with a script. I continued to have this dyskinesia type movements....It was awful!!! I had received phenergan before with no ill effects but now I say im allergic to avoid the possibility of this, Anyone else ever heard of this? How about the MD who dismissed this reaction? I was too sick to pursue it further at the time but it was really scary!