wrong route phenergan?

[cybernurse614]

I work at a OB/GYN clinic. I am a new RN and was asked to give phenergan IV push into already started IV. I asked the doctor if I should give the medication IM rather than IV after being warned of possible complications. The doctor wanted IV and I was advised to go slow. I diluted 25mg in 10ml 0.9% NS. The tubing used in our office requires needles for injecting into the port which I was unfamiliar with. I used a saline lock and administered over 10 min. Then restarted the IV to finish off last 500ml of LR. Patient had no complaints of pain, redness or tenderness. Now I am reading about all the complications and freaking out! Any advice would be helpful. Am I overstressing out?

[lmc512]

I might have missed something, but just tonight I have given several doses of IV Phenergan 25mg to various patients. As for using a needle to inject into the port, there is nothing wrong with it other than needleless systems are safer. You diluted it and you pushed it slow, nothing much else to it. i have only had one pt in several years have any reaction to it. It made her very anxious and basically mean, but then it wore off and she was normal again.

[allthingsbright]

We give it IV all the time at my facility-to our OB pts-diluted of course. It IS really hard on the veins! I like to flush a little before and after as well.

[P_RN, ADN, RN]

Needle systems are illegal.....aren't they? I thoguht it was law by now. What compoany tubing are you using, surely then make an adapter.

[MissouriBSNstudent]

I don't think they're illegal. The women's health clinic where I work part-time still uses the needle systems. I hate those things! I was trained with completely needless systems.

[Agnus]

Phenergan IV is the most common route ordered.

I would be more concerned about an IV system that uses needles.

I would be more concerned about using any system that I was not familar with. Get some training and instruction in anything that is new to you.

[Tweety, BSN, RN]

It is recommended never to give phenergan IV. That said, it does sound like you gave it properly - diluted, slowly with assurance of a good patient IV. Complications arise when it infiltrates or is accidentally given arterially, which is you have a port wouldn't seem a concern. I presume "port" is short for an implanted port-a-cath?

Make sure your clinic doesn't have a policy against it. My hospital doesn't allow it to be given IV anymore. But I've given it IV successfully for 15 years prior.

[Spidey's mom, ADN, BSN, RN]

There are many threads here on AN about IV Phenergan and I'm always surprised by the vehemence regarding NOT giving it IV.

We give it all the time and I've been a nurse for 10 years and no one has complained and no veins have been hurt.

My understanding from the folks who are concerned about IV usage is that diluting it does not matter - it is the pH that makes it harsh and diluting it does not help that.

I still dilute it.

steph

[Spidey's mom, ADN, BSN, RN]

Also the local ambulance companies use needle tubing. And some local clinics too. I don't think it is illegal.

steph

[BrnEyedGirl, BSN, MSN, RN, APRN]

Per hosp policy we can no longer push phenergan,.and yes it is the ph that is so hard on the vien and if for some reason your IV infiltrates durring the push it's very hard on the tissue! Google it and you'll see some horrible pics of infiltrated phenergan. Diluting up to 25mg in 50ml of NS or D5 does change the ph and makes it less likely to cause damage if infiltrated. BTW when you give it IM make sure it's deep IM or you can run into the same problems!

I must admit that as little as 4 yrs ago I was pushing 25mg all the time,.but I do understand that just because I personally have never seen a problem doesn't mean that a real risk doesn't indeed exist!

[mscsrjhm]

My daughter (20s) has veins that were permantly damaged by phenergan pushes. Terrible burning, ulnar and median veins now like hard rope. But, she will tell you that the pain and damage came from undiluted phenergan being pushed quickly. She actually had a nurse tell her "here comes the burn" after the nurse was told to dilute and push slowly- nurse got angry and ignored her. That was 5 years ago- that vein is now useless.

She now has a port (yeah).

Slow and diluted has always worked fine for me, as I give it over 10+ minutes, but I have worked with nurses who haven't taken the time.

[MIA-RN]

You are okay to be worried and cautious. Phenergan can give people lots of problems if/when it extravasates. Even if it doesn't damage the veins and tissue, it still can burn terribly and cause the patient pain.

As it stands now in my facility, the only way to give phenergan is IM or diluted in 50ml NS. I heard recently that soon we will not be allowed to give it IM either.

Where I used to work we could give it IVP but it had to be diluted in 10cc NS and given over 2 - 5 minutes. I still hung it in a 50cc bag, after seeing some of the pictures of the complications.