Giving iv meds through running line

SaoirseRN · Nov 25, 2012

Generally if the patient has a running line, I put the med in a minibag and run it on a secondary set up as long as the patient isn't at risk for fluid overload.

Anna Flaxis, BSN, RN · Nov 25, 2012

At my facility, we do not give Phenergan IV at all.

I'll echo what others have said. If the medication is compatible with the fluid you're running, you can simply do a slow push in at the port closest to the patient. If incompatible, you stop the pump, flush, give the med, flush, then start the pump.

Altra, BSN, RN · Nov 25, 2012

Phenergan has to be mixed in a bag of Normal Saline, hung as Piggy Back, not pushed IV push anymore due to caustic nature of med to vein....Believe that was enacted Jan 2011 across USA.

You might be referring to the FDA-required black box warning labeling, effective in 2009. The black box labeling warns of potential tissue damage from extravasation of the drug, and suggests IM administration as the preferred route. It helps to understand what is law, what is institution-specific policy, and what is generally accepted as good practice based on clinical/practical application research.

Clinical evidence of the vesicant properties of promethazine is plentiful. Widely used drug guides and the recommendation from Phenergan's manufacturer all state that it should be diluted in at least 10mL NSS before administration.

Your institution may very well have a policy requiring promethazine to be given IVPB at your institution. That policy cannot dictate practice elsewhere.

echoRNC711, BSN · Nov 25, 2012

Be sure potassium is not in the IVF or be mindful of any IVPB/ K-supps that may have been infusing into this line before. I made a big mistake while on orientation in ICU. I gave Morphine via cordis line . I did ask "which port " and was told "anyone ". My error occurred in flushing the line after admin.. The line had previously had epinephrine. The stopcock was "off " to that drug but some drug was still in the line. That was a terrifying experience as I watched the pt heart rate fly. (yes,pt survived and a hard lessen learned )I personally only flush a line where plain IVF is all that has run through it. Perhaps a little over cautious but I even a little left over vanco in tubing could be enough when bolused to give red man syndrome.

MInurse.st · Nov 25, 2012

Phenergan has to be mixed in a bag of Normal Saline, hung as Piggy Back, not pushed IV push anymore due to caustic nature of med to vein....Believe that was enacted Jan 2011 across USA. NEVER push IV meds above a pump, EVER! Push IV meds port closest to patients, if slow IV, push flush behind med. HOPE that helps.

I work on a surgery floor. Phenergan is a commonly prescribed med, and we give it IV push.

LogCabinMom · Nov 26, 2012

1. Always make sure your meds are compatible. I don't remember everything day-to-day and still check drug books.

2. I dilute, then push in port closest to pt, if it's a slow push I simply watch the clock. If I don't have time, I put in on the secondary port (as a syringe) and program it.

3. If I'm pushing in the port closest to pt, I draw back a couple cc's, then flush that through.

turnforthenurse, MSN, NP · Nov 26, 2012

I work on a surgery floor. Phenergan is a commonly prescribed med, and we give it IV push.

It just depends on your facility. Where I work we are not supposed to give Phenergan IV under any circumstances. If the MD demands it, then the MD needs to administer it. It doesn't matter how much we dilute the med, either. Phenergan is usually always administered IM unless the MD orders it PO.

Anna Flaxis, BSN, RN · Nov 27, 2012

...or PR.

turnforthenurse, MSN, NP · Nov 27, 2012

...or PR.

Yes, yes, that too. :)