diluted IM Phenergan?

TazziRN, RN · Apr 18, 2008

Why not? It would mean more solution injected so might have to be divided depending on how much it's diluted, but why not?

Trauma Columnist · Apr 18, 2008

What's the volume?

RNwondering · Apr 18, 2008

We've commonly done that in our ED. Normally our volume is so low, the docs will order 12.5 or 25mg which is a ml or less so we will dilute it some. I've found however that people still say it burns. Recently though, I think it's been awhile since I've given it IM or IV; our Docs are on a Zofran kick.

UM Review RN, ASN, RN · Apr 18, 2008

Has anyone ever heard of diluting Phenergan to give IM? A fellow nurse said he has been doing it to help with the burning. I can't find any info on it at all...of course diluted to give IV, but IM????

Nope, never heard of it.

fultzymom · Apr 18, 2008

I have never diluted to give it IM. I have for IV because that it what it says to do. I can testify that it does burn when given IM because I had it one time. It burned for a long time. I guess it might not hurt to dilute with NS as long as you don't exceed that MLs for your injection site but I don't know if I would do it without asking a Pharm or the doc.

LaeDeesNP · Apr 18, 2008

I work in a military health clinic and give IM Phenergan almost every day at work. I always dilute it 1:1 with NS to decrease the burning sensation. If the order states 25 mg phenergan, I end up giving 2 ml fluid into my injection site. We always give it in the butt, which is an ok site for 2 ml. I believe 2 ml is the max amount of fluid you can inject via the IM route, but I may have that wrong. It's been a while since I've looked that up! Either way, some of my patient's still say it stings and others say it's fine. It's all in the patient's perception of pain/discomfort...as always! :)

miko014 · Apr 18, 2008

I hate giving phenergan period. I guess PO is okay, but if you're puking, a pill probably isn't the way to go. IV phenergan is classified as a vesicant now, I'm sure we all know about the young lady who lost the fingers. But knowing what it can do to SQ tissue, it's no wonder it burns when given IM. And what if you use a needle that is too short? There are too many risks involved with giving it IM or IV. I hate it!!! Thankfully our docs will give zofran or compazine (which I don't like either, but at least it won't make your arm fall off!) IV before phenergan IM...unless there is a good reason to make a pt go through a risky, painful IM injection.

emersushea · Apr 18, 2008

I think the main issue with dilution would be that you are limited to using a large muscle for IM administration. I believe 2-5 mL is the max for IM injection in the ventrogluteal (which i've read is the current preferred site) according to most institutions, so it would all depend on how much you are diluting by.

Personally, I would be prone to using Z-track and pressure; or even distraction as I do not believe its caustic effects are such as when it administered IV. But it'd be interesting to see the literature about it.

meownsmile, BSN, RN · Apr 19, 2008

Docs are on a zofran kick. But recently we are seeing fewer and fewer orders for it. Apparently the insurance companies are throwing a fit because of its cost as compared to inapsine or phenergan.

allnurses Guide · Apr 19, 2008

I have never seen an IM medication diluted when not following the manufacture's recommendation. What I would worry about is changing the absorbtion rate/pharmokinetics. A larger volume is going to take longer to absorb by the muscle so you could potentially prolonging the onset of set of action, prolonging its action etc.

P_RN, ADN, RN · Apr 19, 2008

Isn't inapsine being used less because of the tordsades problem? My max for a deep im in the butt is 3 IF they have a sufficient mass back there. Otherwise split it.