Promethazine IV Question

I recently had my gall bladder removed and the physician wrote for phenegran IV. I can tell you that my arm hurt for days after I got out of the hospital. My IV was in the AC and the vein running up my arm to my shoulder was very tender to the touch. After all the Demerol that I had, I'm not sure if the nurse was diluting the phenegran or not but I can tell you that it really hurts for several days after administration. I am on a push to get our ER docs not to prescribe phenegran IV. I think it needs to be reserved for IM use.

I had 12.5 infused via IV last weekend, following D50 and K+ in the same vein. One of these alone is caustic. My arm still hurts but the swelling is down. I know the nurse flushed with 5 cc NS before/after the Phenergan but we literally watched my vein get red after the final flush. I am amazed you have not found literature as there was a push last year to decrease the use of Phenergan in elderly patients. Look in gerontological nursing journals. Good luck. It is a worthwhile topic.

Yikes! It's a wonder your arm didn't fall off!

The hospital where I have clinicals policy is to never give over 12.5 of Promethazine, and to always dilute with 10 mls of NS. It also helps to administer the phenergan in the furthest port from the patient, this makes it go in even slower.
I've seen people lose fingers from phenergan, it's too bad physicians can't order more PO...at least for those patients with the nausea without vomiting.

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? I especially hate giving this med to someone with an already compromised peripheral site (even more if their mental health is in question). I have learned from a physician that is well respected that 6.25mg is usually a great dose for short term use on a patient that has never been exposed to it. I also have patients that may have had Phenergan before and they refuse the entire dose because they know the burning it causes, but they still want relief. I actually was given Phenergan IVP undiluted before I was a nurse and I thought I was going to die. It burned horrifically and left my vein feeling like a hard rope...almost petrified for months. On top of that it made me feel like I was going to die. I was paranoid that I couldn't keep my eyes open...LOL I have terrible insomnia. I guess I should have welcomed it but I really believe that this drug should be reviewed by the FDA again. Maybe placed in another class of medications due to the numerous complaints.

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

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!!

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!

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

At our facility Phenergan is diliuted with I think 20 cc of NS and ran on a pump over 15 minutes.