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 productthat 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 afterinfiltration or inadvertent intra-arterial injection, ismp recommends thatthe fda reexamine the product labeling and consider eliminating theiv route of administration. severe tissue damage can occur regardless of the route of parenteraladministration, although intravenous and inadvertent intra-arterial orsubcutaneous administration results in more significant complications,including: pain, burning, swelling, erythema, severe spasm of vessels, thrombophlebitis, nerve damage, paralysis, phlebitis, abscess, venousthrombosis, tissue necrosis, and gangrene. sometimes surgical interventionhas been required, including fasciotomy, skin graft, and amputation.the true extent of this problem may be unknown. however, scores ofreports submitted to ismp, usp, and the pennsylvania patient safetyreporting system; articles in professional literature; news of lawsuits inthe media; and communications on various internet listservs and messageboards (ismp, national patient safety foundation, allnurses.com,and others) suggest that patient harm may be occurring more frequentlythan recognized. a few examples follow. 0 Likes