Change in IV Phenergan Policy

[RNKPCE]

Have your hospitals recently changed their policy for IV Phenergan? Just this week I noticed that we now have to try 6.25mg first then 12.5mg, it has to be diluted in 20ml and given over 15 minutes. Now I know why I got in report from the ER that they gave a patient Zofran for nausea. They never use to give Zofran. I looked up some stuff on the internet and I guess Phenergan is a vesicant that can cause loss of limb if injected interarterial. What are the other reasons for the change? If this is true I can see why the policy change, but I am sure a vomiting patient will not like waiting 15 minutes for the Phenergan to be injected.

[MedSurgeNewbie]

I am new but we still use 12.5 I dilute it becuse I heard it was rough on teh vessels but never heard about 15 min push time -

[MomNRN, BSN, RN]

I always dilute mine and give it in the furthest port. I have not heard the slow push time.

[Wile E Coyote, ASN, RN]

I should think you need to ask you facilities policy makers this question. Is their decision evidence-based or ???

A 15 minute IVP would catch my attention, and I haven't heard anything out here in AZ, if that means anything.

[Anagray, BSN]

In our medroom we have a picture of a hand that belonged to a 21 year old student who received 25 mg of phenergan IV for vomiting induced by gastroenteritis. Her fingers became necrotic and had to be removed. this picture is in my head every time I withdraw phenergan.

15 min IVP? not realistic.

[MissBeehaves]

Our facility took Phenergan off the formulary altogether. Orders are automatically subbed with compazine.

[MomNRN, BSN, RN]

I had a pt today who complained of the burn and then had intense itching with transient redness to her forearm.

I used my usual protocol: dilute the 12.5mg of phenergan in 10ml of saline and push slowly - usually over 2.5 minutes. She also received 4mg of morphine about 3 minutes after the phenergan.

The burn and itch subsided after about 4 minutes - the redness approximately 15 minutes later.

This did make me nervous. I use the same protocol every time. I never inject directly into a lock. I always have saline running - most of the time wide open.

I still am not sure if it was a reaction to the morphine, the phenergan, or the combo.

[Nursing On The Run]

I've seen that picture of the hand, destroyed by a phenergan injection. I think the gist of the article that went with it was: Don't inject into anything less than a #20, and don't inject into an IV situated in a hand. Always dilute (the pain itself probably makes most nurses do this). And pay attention/investigate if a patient reports continuing pain at the site of a phenergan injection.

We still give it, but with the above conditions.

HTH

[MissJoRN, RN]

Our hospital changed policy- we're not giving it any more at all. If they do want you to give a 15 min push- can they get a few bard pumps for you? Our hospital only had them for peds but I used them a couple times for adults who needed slooow pushes.

[VickyRN, MSN, DNP, RN]

This article is very informative: http://nsweb.nursingspectrum.com/NurseNewsEzine/DrugNews/item.cfm?ID=237

[Anjann, RN]

They say that JACO is trying to discourage IV Phenergan altogether R/T necrosis, pt. discomfort, and the fact that it can blow the IV line if given repeatedly. I have heard that the suppositories and IM routes are still acceptable.

One local hospital I was actually a patient in, tried to use Phernergan only as a last resort (opting for Zofran or compazine). If the Phenergan was used, it was ALWAYS cut into 20ml NS standard and pushed over about 10 minutes. They stated they thought it would soon be removed from the formulary.

The hospital I currently work at has just gone from diluting Phenergan with 10ml to 20ml and they try not to use it at all in anticipation of it being removed from the formulary.

[rgroyer1RNBSN, BSN, RN]

we still use phenergan, but the docs order us to dilute it in 50ml/100ml of saline and piggyback it into the primary line with a slow drip.