Action needed to prevent serious tissue injury with IV promethazine (Phenergan)

since it comes up frequently here as a topic (in fact, there's a mention of allnurses.com in the article!) i thought i'd post the link to this month's nurse ismp medication safety alert, which has an excellent article on iv phenergan use "action needed to prevent serious tissue injury with iv promethazine". i did a quick search and it didn't look as if anyone else had posted this,so here it is:

http://www.ismp.org/newsletters/nursing/issues/nurseadviseerr200608.pdf

snippet:

promethazine (phenergan) injection is a commonly used product

that possesses antihistamine, sedative, anti-motion sickness, and antiemetic effects. the drug is also a known vesicant which is highly caustic to the intima of blood vessels and surrounding tissue. formulated with phenol, promethazine has a ph between 4 and 5.5. although deep intramuscular injection into a large muscle is the preferred parenteral route of administration, product labeling states that the drug may also be given by slow iv push, which is how it is typically given in most hospitals.

however, due to the frequency of severe, tragic, local injuries after

infiltration or inadvertent intra-arterial injection, ismp recommends that

the fda reexamine the product labeling and consider eliminating the

iv route of administration.

severe tissue damage can occur regardless of the route of parenteral

administration, although intravenous and inadvertent intra-arterial or

subcutaneous administration results in more significant complications,

including: pain, burning, swelling, erythema, severe spasm of vessels, thrombophlebitis, nerve damage, paralysis, phlebitis, abscess, venous

thrombosis, tissue necrosis, and gangrene. sometimes surgical intervention

has been required, including fasciotomy, skin graft, and amputation.

the true extent of this problem may be unknown. however, scores of

reports submitted to ismp, usp, and the pennsylvania patient safety

reporting system; articles in professional literature; news of lawsuits in

the media; and communications on various internet listservs and message

boards (ismp, national patient safety foundation, allnurses.com,

and others) suggest that patient harm may be occurring more frequently

than recognized. a few examples follow.