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.

[Vida]

Anyone know what is TOO slow? Reading all this is making me nervous.

Vida

[West_Coast_Ken, BSN, RN]

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.

Here's a link to a story and picture of a 19 year old student. Not sure if it's the same story as you mention, but it's pretty powerful.

http://www.thedailyworld.com/articles/2005/12/07/local_news/02news.prt

[jamminworld]

We are no longer allowed to give phenergan IV push it was actually completed removed off the floor to prevent this. Now we have to get it from pharmacy in a 50ml bag and given over 15min. It is horrible because when your pt has N/V and you have to request the dose from pharmacy and wait an hour to get the medicine pt isnt very happy. The hospital I work at doesnt think much and then wonders why satisfaction is so low.

[Nemhain]

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.

My hospital wants it diluted in at least 20ml and pushed over 5 minutes. I end up doing almost the same as you: 50ml of NS to 12.5 mg of Phenergan and I run it over 20 minutes (150 ml/hr) on a pump. My hospitals allows nurses to use their own discretion (from a lengthy set of standing orders), but 20 ml is the minimal amount of fluid for 12.5 mg of phenergan.

[Roy Fokker, BSN, RN]

I always dilute my doses in 20 ml syringes and run it using a mini-infuser. About the only thing I do without the infuser is Toradol (again, diluted because it burns like crazy as it goes in). I use the mini infuser for things like Metoprolol as well.

Does anyone honestly have the time to sit and IVP something over 15-20 minutes?!!

[jamminworld]

If I had 15-20mins extra I might just eat or use the bathroom for once. :)

[mamalle]

havent seen anything change in either the outpatient pacu or er I work in. I always have given it from the farthest port slowly. I never given it straight IV push into the saline lock.

[scrubsnhugsRN]

I just have to say that this post has completely changed the way I give phenergen.

I now give it 6.25 diluted in a 20 ml syringe, very slow push.

I have even brought it up with a few docs after reading this site, and a pharmicist, regarding changes in hospital policies around the nation. The pharmicist was a aware of the new trend, the doc wasn't. I have even spoke with the nurses about..so we all are changing our practices as a matter of course. I love this site!

[Indy, LPN, LVN]

In 2003 there was a thread, maybe early 2004, about phenergan IV and it was quite lengthy and instructive. I was in my first year nursing school and my teachers had no clue what I was talking about. Since I graduated I've been careful with phenergan, and now look, the facility I'm at has changed their guidelines.

When this came down our NM sent us an email saying we didn't really have to pay attention to the guidelines unless JCAHO surveyors were on the floor, but use our discretion. Hm. Interesting eh?

I like to have fluids going and put in the higher port, slowly. That does seem to lessen irritation down to almost nothing. In CHFers who can't take the fluid, I'll dilute in 10cc syringe with NS and carry one or two extra 10cc flushes with me. Push a few cc of the phenergan solution, push a little flush, back and forth. It can take a few minutes but I really want people to retain their limbs. Plus you can assess and see if it's helping their nausea and so forth.

You know, I don't think it needs to be removed from anyone's formulary; that's kind of a kneejerk reaction. However; it's still manufactured in 25mg vials. If the manufacturer would just make it in 6-12 mg vials instead that'd be nice.

[DEB52]

Since I started reading this thread, I have brought the issue of Phenergan IVP to my manager and the staff. My manager talked to the head of OB. I contacted the pharmacy. They did have something written up on it . So now our unit will be giving Phenergan IVP differently and more safe. Thanks for this thread and for all the GREAT threads that everyone posts!!

[rgroyer1RNBSN, BSN, RN]

Our docs always request it piggybacked now in 50 ml ns bags with a slow drip and thats the only way well give it. We had another Er nurse that gave it Im in the deltoid and it necrosed the guys limb she thought she gave it Im but it was more like sub-q.

[Nemhain]

No policy at my hospital, but almost everybody dilutes 25 mg of Phenergan in 50ml of normal saline and hang it as a piggy back. We don't need an order to do that (hang it as a PB).