Promethazine IV Question

BrandieRNq · Jan 19, 2003, 09:12 PM

I have had Phenergan IV in the ER recently. PAIN and BURNING!! I wish I had been able to notice if it was diluted or pushed too fast however, I was not feeling well and didn't care to notice at the time. I had a red mark up the vein appr. 4 inches for about a month. Even now, there is a hard palpable area along the vein, appr. 3/4" in length. Sclerosed forever, I'm sure.

**P_RN** · Jan 19, 2003, 10:39 PM

If I remember correctly on the 50 mg vial it's printed NOT FOR IV USE......
Even w/ IV wide open the stuff burns like heck. Dilute it to at least 10 cc and I don't ever recall giving over 12.5 IV.

In the Elderly Reglan can drive them batty, and give all kinds of EP symptoms in almost everyone. Our docs pretty much changed to Zofran et al.

litepath · Feb 17, 2003, 11:42 AM

FDA site says it's IV legal. I've always been taught to diute then push over two minutes. My clinical instructor showed me in her reference where i didn't have to do that for 25mg or less the other day, but allowed me to push it my way anyway. From what I understand pH and tonicity play an important role in the potential for chemical phlebitis, but haven't found any references that I have at hand to aid me with that info~~

Patricia116 · May 08, 2003, 09:15 PM

Originally posted by CATHYW
Please, please, please! Always, and forever dilute promethazine when it is to be given IV. Our ER POLICY was that it must always be diluted in 5 ml NS saline and administered slow IVP, even when given into a wide-open line (as in 1000cc NS WO). After this policy was instituted, we never had the problem of sensitivity or patient complaints arise again. I would also caution anyone giving this medication to an elderly person to ask the MD if they might cut the dose in half, or use something else (such as Reglan), as I have seen some elder folks become positively wild, and nearly uncontrollable when this drug was administered.

Conversely, it is not uncommon for elderly patients to become nearly comatose following 12.5 mg IV of phenergan. In view of these unpredictable results, I agree, it would be better to consider an alternate antiemetic for the elderly patient.

amk1964 · May 09, 2003, 01:28 AM

I've never seen a policy on dilution, but its a good idea.

to capgirl,
When I was still in Buffalo we rarely gave demerol ivp. It was almost always ordered with vistaril IM.

NightMoonRN · May 09, 2003, 02:06 AM

We dilute with at least 5cc of dilutant. The problem we've been having is untoward affects of restlessness and panic as nursenatalie mentions. One can push it as slowly as you can and be as diluted as ever and still get these effects more frequently than we'd like. Was wondering if it is a batch problem at the drug manufacturing plant.
We give a fluid bolus and also Benadryl 25 mg IVP slowly when this happens. Seems to help shorten recovery time.

healingtouchRN · May 21, 2003, 07:03 AM

must dilute per policy @ my place. I often find the tell-tell signs of someone not diluting when I go out to the med-surg floor (when super says "can you start another IV on so & so?") I ask the patient if the drug was in a big syringe or little syringe? You know the answer. It is very caustic to the vein!!!!!! Must read the nurse drug book on giving the meds. OUCH!

webbiedebbie · May 21, 2003, 07:23 AM

I had to give Phenergan 12.5 ml IV just the other night. I had read the original post and diluted it in 9 cc. When I came back the next night, the pt's IV had to be restarted on the day shift d/t phlebitis. You can bet, I gave the next one diluted in 20 ml. Haven't heard yet if the pt had any problem with that one.

purplemania · May 21, 2003, 08:00 AM

have you searched under chemical phlebitis, extravasation? Get the pharmD to get info from the drug rep-they can ask for recent studies (you MIGHT get it yourself) and the studies (which are biased) will have references. Have you had incident of psychotic episode following infusion of this drug? Happens with peds sometimes.

Zoey65 · Apr 17, 2006, 03:41 PM

Re: Promethazine IV Question

Oh my goodness, I am back in nursing after being out for 10years. I only have experience in a nursing home where I gave no meds or anything else. I am relying on my institution and preceptors to guide me and have been giving IV med w/o diluting most of them. I try to read what they are for but haven't seen where to dilute. I need advise on where to find this info.

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Promethazine IV Question

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