Promethazine IV Question - page 6

From personal experience as a patient, I know that when promethazine 25 mg/ml is administered undiluted into a peripheral IV site it burns and can cause chemical phlebitis. I am hoping to write my... Read More

  1. by   hogan4736
    Quote from jennifer_25_nurse
    Okay question? Even if the physician orders the Phenergan 25mg IVP now can you not just decrease to dose to what you believe sufficient for that patients circumstance and if 6.25 is not enough in 15 minutes with no relief of nausea then give another 6.25?
    good question...

    I believe, since it's outside of the ordered dose, that you would be prescribing...

    Our CNO revealed to us (the house sups) that when she was a staff nurse, if she had a range order: Morphine 4-6 mg q 4 hrs, she would often give 2 mg, as she feared "the pt was tiny and frail, and couldn't tolerate 4 mg."

    GET THE ORDER CHANGED
  2. by   kbear
    Our instituiton has a policy that any dose of IV phenergan has to be diluted in 50cc NS and piggybacked over 15 minutes. The Institute of Safe Medication Practice(ISMP) has a website that references awful cases of sloughing and necrosis of tissue and even amputations of fingers from IV phenergan damage!!
  3. by   janetjanetbobanet
    Quote from P_RN
    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.
    Not trying to change the subject of this thread, but seeing this on reglan makes me want to add my two cents worth. I got undiluted reglan given directly into a free-flowing IV on my way to a lap chole. By the time I reached the OR door I was shaking uncontrollably to the point where I was unable to talk clearly and was extremely anxious. I would have climbed off the gurney and cancelled the surgery on the spot had I been physically able to do so. The last thing I remember is hearing the anesthesiologist tell me he was going to give me some versed for the symptoms. Please always give reglan slowly and well diluted, too!
  4. by   hogan4736
    Not trying to hijack, but I have been diluting anti-emetics (phenergan inapsine, reglan, zofran) in litre bags since 1997...I discovered this after pushing compazine (rarely used these days) too fast, and the pt wanted to crawl out of his skin, and rip his IV out...

    Think about it...

    acute n/v gets a litre bag 99% of the time...

    slower is ALWAYS better than faster...

    this isn't brain surgery
  5. by   grace90
    At our facility Phenergan is diliuted with I think 20 cc of NS and ran on a pump over 15 minutes.
  6. by   BurnunitRN
    just as many others on here, i have been at the receiving end of the painful effects of IV phenergan. i was getting it scheduled Q4 hrs...and pretty much had to get a new IV every 3rd dose from excrutiating phlebitis...i was in the hospital a little over 2 weeks...never got a central line...you can probably imagine i went through gobs and gobs of IV's....and ya know, by the time i left, there was not one vein in my body that you could have put an IV into. it was pathetic. anyway, at the hospital that i work at, phenergan is only given via IV piggyback. the pharmacy dilutes it in 50cc NS and sends it up to us. no IVP allowed! i'm interested to see what you find!

    also, in the burn unit, we give demerol sometimes. we try other pain meds first, but often, after the patient has been here long enough and develops tolerance to everything else, we have to resort to demerol.
  7. by   grace90
    Our hospital still uses Demerol quite a bit. I think it's time for me to do some research and get some information to our supervisors, and the chief nursing officer, among others. They need to get with the program.
    I've never gotten IV Phenergan that I know of (hard to know what's up when you're sedated in an ICU), but I got it IM during one of my labors and it worked pretty darn well. Sure it stung, but the sting went away and so did my puking.

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