Prednisone

suanna · May 10, 2014

Just speaking from experience…I pushed dexamethasone too quickly once. Right after pushing, the pt moaned, said something to the effect of "holy poo" and described and intense burning in the genital/anal region (I forget her exact words for the anatomy, but I'm sure I can't post it here). Apparently other the other ER nurses about this reaction…it seems to be well known. I have no idea of the mechanism, but now I always put my dexamethasone in a 50 mL bag of NSS and piggyback it in. I always do a (fairly) flow push of methylprednisolone and have never seen such a reaction.

Thanks for not getting into the semantic nit-picking about Owlieo.Os use of the drug name "prednisone" when it was obvious the meaning was I.V. corticosteroid. I haven't see this reaction and will be on the lookout for it in the future;(and I've been in acute care for 30 years). I recently changed from an area where I almost never gave IV corticosteroids to one where I give them once a week or so. Does anyone know if it occurs with both Solu-Medrol and Solu-Cortef? Thanks to OwlieO.O for posting about this.

Guests · May 11, 2014

I would of course research any drugs I give before giving them

That's a great attitude but the reality is that you don't always have this luxury... particularly as a newer nurse in an ED.

Instead, you rely on some general principles:

(1) Low and slow

lowest possible dose for range meds and lowest possible concentration... that is, in general, diluting is a good thing

other than adenosine and epi in a code, pretty much nothing that you want to push fast

(2) Bigger is better

Big veins and freely flowing lines tolerate most meds much better than do stiff, little ones.

(3) Anaphylaxis kills

That is, check allergies... every patient, every dose

(4) AIE, AIE, AIE, AIE (assess, intervene, evaluate)

That is, bird-dog your patients after you medicate them... you'll never know all the side effects nor even lots of the relatively common ones

(5) ABCD, ABCD, ABCD

If they're awake, breathing, and their pressure's OK... most of the other stuff passes pretty quickly... and if you tell a doc, they'll generally say, "OK, keep an eye on 'em"

(6) Chemo is poison

Literally, chemo agents are poisons... and nobody should touch that stuff except the people who know what they're doing...

(7) Don't screw around with chemistry

Do not mix anything whose compatibility you haven't verified... you can cause irreparable harm and never even know it...

And realize that compatibility isn't necessarily a yes/no... sometimes it's concentration dependent so make sure you really understand what that term means... or just start another line (of course, if you've got time for that, you've probably got time for the research that you first mentioned).

(8) Doses matter

Generally speaking, the phials and tablets are sized that way for a reason... they're generally cover most common doses... if you're pulling multiple phials or multiple tabs, be concerned... sometimes that's what it takes, but that's a good reason to slow down and triple check.

And for goodness sake, if you haven't *MASTERED* dosage calculations by the time you graduate... and I mean you can solve any problem you come across, and can solve the simple ones in your head (and then verify on paper), keep at it until you have.

.

the reality is that you don't always have this luxury (researching meds)...

Please don't misinterpret this as a cavalier attitude toward meds... quite the contrary.

But do recognize that you may not know everything there is to know about every med you give before you give it and that general safe-administration practices will help you out...

and I don't remember nearly so much emphasis on the fundamentals that I've described as I do emphasis on trying to memorize a ton of drug details.

Sharon RN, BSN · Apr 7, 2016

I am an R.N. and a little while ago, I had Decadron/Dexamethasone pushed rapidly in my hep lock over 30 seconds. I had always seen it diluted in a bag of Normal saline. I got temporary pretty severe perineal strange pain which it seems others on this site have experience with.

Then the back of my left arm which was the arm used to administrate it, developed pretty severe pain.

The heplock was not flushed.

I just thought that was mighty fast.

I know how hard it is when you are busy to push IV drugs slowly, depending on the med.

I am finding conflicting information about length of time it should be pushed on reliable sites.

My nurse said that happens in about 1 out of a hundred people.

I found that to be a strange reaction, and it was a feeling of discomfort I had never experienced any where in my body before.

Any Nurse Anesthesist, Docs, N.P's, Pharmacists, etc. have any thoughts such as whether it should have been pushed more slowly and whether the heplock should have been flushed afterward?

I found the reaction rather curious as to the pathology of the perineal sensation and would especially like information on that.

AZQuik · Apr 7, 2016

A flush would have pushed more dec in. And yes it should have been flushed. Given dec thousands of times and haven't had a pt tell me this was their experience. Maybe I pushed it slow enough (most things I push are slow unless it's an unstable pt then I don't care how they feel I want them to stay alive, or I haven't ever pushed it on someone who had that reaction)

allnurses Guide · Apr 7, 2016

I give IV push Solu-Medrol pretty often for anaphylaxis, and have never had a patient report the genital pain/itching. I push it fairly slowly and always flush with saline afterwards.

NanikRN · Apr 7, 2016

Onc. Nurs here -- dexamethasone 10 mg and up can cause the genital burning if not diluted/ given slowly. We call it the ants-in-your-pants syndrome, fire ants that is!!

I always give mine slowly out of compassion ðŸ˜ƒ