Promethazine IV Question

  1. 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 master's thesis on this subject and cannot locate any research data to support my anecdotal finding. If you know of any documentation to support my position, please e-mail it to me. I would also like to hear from anyone who has experienced a similar result from phenergan IVP.
    Thanks,
    Paul
    •  
  2. 71 Comments

  3. by   JillRN
    Hello,

    I am responding to your request for anectdotal information on phenergan IV. Although I do not have current literature to refer you to, I can attest that as a patient last year with a GI bleed, I received many doses of IV phenergan. My IV had to be rotated several times, and it took nearly nine months for a very dark line following my vein where the last IV was to disappear. It remained tender during those 9 months.

    For several of the doses, I had a new RN who gave the first dose undiluted and very rapidly - almost like a heplock flush. I can assure you I thought I was having an anaphylactic reaction: I became flushed, had shortness of breath, I felt my throat was closing off and the room was spinning and I had palpitations. It was quite frightening. Once I explained it needed to be diluted I did not experience any of those effects again. However, it is very damaging to the veins.

    Good luck with your thesis, I would be interested in whatever info you find in journals.

    Jill
  4. 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.
  5. by   misti_z
    Any drug book tells you to dilute in at least 5cc NS and give slow IVP like Kathy stated. Recently had a pt who had to have a vein stripped b/c of receiving phenergan IV undiluted and to quickly.
  6. by   SharonH, RN
    In the institutions I've worked, the dilution for Phenergan is 9cc and I think that is prudent. I always push it very, very slow.
  7. by   misti_z
    My hospital policy is 7cc. And I flush after, even when fluids are going, so that what is left in the tubing will not be pushed in too fast.
  8. by   shannonRN
    our policy has no policy that i am aware of. i dilute it in 5cc and give over at least 1 minute. if you do come across any info...please send it my way. i would be interested in getting a policy initiated. and i, of course, will keep my eyes open and send anything i can find your way. good luck. it sounds like a great thesis.
  9. by   jayna
    shannonRn, you don't have policy?????..Too bad!!
    well, we don't have policy too....hahaha
    but for phenergan 25mg, it's 1cc so we dilute it wih 9cc saline..
    and give intravenously slowly for like one minute......have fun..
  10. by   debbyed
    I always dilute with 10 cc and give slowly. I will usually add the ordered Demerol to this mix without any problems occuring.
  11. by   Julie, RN
    I give phenergan alot. At my hospital the doc's usually write for 6.25mg-12.5mg at a time. We give the full 25mg very rarely. I dilute it in 10cc NS and if fluids are running I hang it as a secondary over 10-20 minutes depending on the pt's vein status. I've pushed it diluted over 5 minutes before and it caused chemical phlebitis.

    Julie M.,RN
  12. by   l.rae
    Paul, I have had an interesting issue regarding IV phenergan. Recently some of the house residents are refusing to order phenergan via IV stating it is not approved for that. The PDR gives the guide lines for IV use . The other evening this came up again so I asked our attending to give me the order for the IV med. when I expressed my frustration over this issue the MD commented "Well, phenergan is not FDA approved for IV use." This was news to me! l.rae RN
  13. by   micro
    news to me too.........
  14. by   Mary Dover
    My husband got IV Phenergan recently for N/V during a GI virus. REALLY messed his vein up. IV fluids were finished, so I guess it was given as an afterthought.
    By late that evening, he started to experience a lot of localized reaction at the IV insertion site, and all the way up his arm, a path that was clear to me, was the path of the vein. I was ready to take him for immediate follow up of course, but men can me hard-headed sometimes(lol). The inflammatory process subsided after a couple of days, but he still has some distal tenderness.
    Last edit by Mary Dover on Apr 7, '02

close