Promethazine IV Question

As an answer to the original post, there are several items to keep in mind. The reason that the Phenergan has such bad effects is all pH related. It is quite acidic (I don't remember - but I think it is around a 4 or so) Do dilution with 0.9% NS doesn't change the pH. So ....

As a practical matter, it could be diluted and then pH reduced to neutral with small addition of NaHCO3. I cannot find a reference detailing a issue with that - but, I do not know as a practical matter. I have thought about it, but my current "position" keeps me from any policy input. Would need some type of standing order or such.

As a practice issue, I ALWAYS dilute everything that goes IVP except Code drugs and adenosine. I generally dilute to a level necessary for the access device the patient is using. Before giving any med in an lock access device, I always aspirate for blood return and then flush the port to be used with a 10-20 ml saline to assure that the site is patent.

There may be differences or no mention as to specific policy, but I think there are some practical "best practices" that benefit patients.

I was in the hospital a month ago and I experienced this first-hand. While this nurse was pushing the phenergan into my IV, I asked her if she diluted it. She said "well, no, I guess I could have". It burnt like heck and I still have a huge lump and my vein is now hard. It literally feels like a big wire in my arm. Good luck with your paper.

Are extrapyramidal effects from Phenergan use usually temporary, or permanent? I gave 25mg per MD order to a 77yo F patient, and have been traumatized since w/her reaction to it. This happened 3 days ago and being a new nurse, I wonder if I can handle this career anymore... =S

The FDA receiently released a warning with regards to phenergan stating it should not be given in a pheripheral iv in the hand and that it should be diluted before administration as it has caused a couple patients the loss of fingers and severe infections secondary to its caustic nature.

20RN: have to be careful with phenergan especially in the elderly as it has antihistamine properties and can make a person really sleepy.

Swtooth

Pt is receiving phenergan, usually for acute nausea, with associated vomiting...Also common w/ the phenergan order, is a litre bolus...

Forget the piggyback and pushing over 5 minutes...

Put the phenergan in the litre bag...It will infuse over 15-60 minutes (depending on the IV size)


I've been doing this for 10+ years, w/ NO side effects...

We are not allowed to give phenergan IV where I work, but PO or PR. Works great though! At another facility I gave a long-term antepartum pt. (81 days) IV Phenergan every 4 hours durning her stay through a central line. she said she could always taste it.

Action needed to prevent serious tissue injury with IV promethazine. This link is the Institte for Safe medical practices and is referenced by most of the other articles I found on this subject.

Phenergan IV will no longer be on my hospital's formulary beginning 1/1/07. Darn shame! Works really well on my concussed patients. I do however agree that the risks outweigh the benefits though. Buy oh my, I do hate vomit!

I have no written info either but I am a nursing student and we as newbies are even taught to dilute phenegran or as stated mix with demerol if ordered. Also, push one full minute. Even the new nurse that pushed it on poster, should have been taught this.

I wonder.. if Promethazine is so risky to administer IV in fear of harming the pt, why is it made the way it is? Is there such thing as a prediluted phenergan? Or would that defeat the action of the med?
Also, if a pt where given the med undiluted for the first time, would that automatically harm the pt greatly? Or is the harm done through repeated use of the IV med?
Thanks.