Phenergan IV changes in policy - page 2
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.... Read More
Feb 10, '07Occupation: RN in ICU Specialty: MICU, SICU,PACU, Travel nursing ; Joined: Feb '05; Posts: 594; Likes: 842I work in a recovery room, and we still give demerol and phenergan ivp like its going out of style. demerol works better than morphine sometimes on the abdominal surgeries and also can help with people who shake postop from the anesthesia. I always dilute phenergan before I give it, and usually start with 6.25 unless its a screaming total knee who refused a spinal or something, they may get a little more :]
Feb 10, '07Occupation: RN Joined: Apr '04; Posts: 441; Likes: 23Wow! I knew Phenergan could be mean to the veins if given straight, but I didn't know it could be this risky. I left working orthopedics 10 months ago and we always gave 25 mg, diluted in 9 cc NS IVP over a minute or two, no matter where the IV was placed. I never had or heard of any problems with it...except that some of the patients liked it a little too much! We gave lots of Zofran too, but of course most patients who'd had Phenergan requested that instead. We also got all the gastric bypass patients on that floor and those surgeons always scheduled TID Reglan the first 24 hrs post-op. We just pushed it straight in. Now that I work on a tele floor, I've learned that Reglan can cause some changes in heart rhythm and we have to give it over two minutes while the CCT watches the monitor. Anybody else heard this?
I learn so much more on this site that they don't teach you in school! Thanks, y'all!
Feb 10, '07Occupation: RN Specialty: 6 year(s) of experience in medical, telemetry, IMC ; From: DE ; Joined: Sep '05; Posts: 188; Likes: 46we had a "phenergan incident" on our floor a couple of months ago (a pt. developled some nasty blisters/wounds form a nurse pushing undiluted phenergan in an iv in the hand) and now our hospital developed a new phenergan policy:
never give phenergan in a saline lock, give only in a running iv.
don't give in an iv in the hand or the wrist, it has to be given in an iv above the wrist line.
always dilute phenergan in at least 10ml of ns.
give in the most distal port of the iv tubing.
Feb 10, '07From: US ; Joined: Jan '05; Posts: 1,008; Likes: 369Only probem I have ever seen is when the nurse did not dilute the medication, unless contraindicated or a emergency, dilution is always a good idea.
Feb 11, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003We still give phenergan and demerol IV. The docs like it. I had a patient with new onset of severe migraines that started in ER with NTG for chest pain. Morphine, fioricet, ultram and something else that I forgot, didn't work. (not all at the same time mind you!) Demerol and phenergan IV worked and she got some sleep and relief.
However, yes, our pharm has changed the protocol to 6.25 IV and if you want higher doses, you gotta:
1. give different route
2. or get doc to write order that specifically says "I do intend to give this dose despite the policy"
And of course, dilute and before they changed the policy on the dose, they had a policy change that said to give phenergan over 10 minutes. Which I've only ever done on one patient. She had an MI several days prior to hospitalization, and couldn't have interventions d/t severe emesis and gastric erosion. I mean the lady vomited so much I had to put vaseline on her mouth and chin every few hours to prevent skin breakdown. Oh, also a history of CVA with right sided paralysis. She was pitiful; no blood thinners per doc, no betablockers per blood pressure, and npo, with no TPN running. Her doc got tired of hearing from me!
Poor lady had... you guessed it... phenergan IV every few hours. And IVF of NS with 40meq KCL, not 20, in every bag. I went so slow with her phenergan that she managed to vomit while I was giving it. Potassium is nasty on the veins as well. The first shift, we blew out two IV's and had to put in two more. (the nice nurse who helped me with her sticks went ahead and put two in, bless her) When I got back the second night, she had two newer ones! OK. Six sticks in 24 hours is just nuts. So. I put up a gravity bag of NS and got OCD about her darn veins. First I called the doc and told him (yes, told) that the IVF was too fast unless he wanted a central line d/t the amount of potassium in it. Good, got that slowed a bit. Of course then he ordered IV prevacid, which is also not good on the veins. Argh. I hung NS to gravity and used the bag instead of the K-laden IVF whenever I had to give anything else in her IV, and would let it go (slowly) for about 1/2 hour or so each time. I know, it ran a risk of screwing up her K level but mygosh. Anyhow, that worked pretty well. She kept her couple IV sites for at least two days doing that, and for once I got compliments from dayshift.
I could certainly see, after that experience, how much better it was for the phenergan to go in a running IV even when diluted. Just as long as the running IV isn't full of K! Our NM told us informally (of course) that we were to just use our nursing judgement and didn't have to give phenergan quite that slowly... makes me chuckle.
Feb 11, '07From: TN, US ; Joined: Mar '05; Posts: 76; Likes: 14We haven't changed our policy, exactly, but there the pharmacy printed up little fliers and posted them all over the place to remind us to dilute the 1ml of Phenergan with at least 10cc NS and administer slooooowly.
Most of us in my department were thinking, "Who DOESN'T already do that?!?" I dilute just about everything I give, except ACLS drugs in code situations, etc. I've not had a problem with it, both as a nurse administering it or as a patient receiving it. (I'm a world champion puker...Phenergan has saved my heinie many a time. )
Feb 12, '07Occupation: RN Specialty: 14 year(s) of experience in tele, stepdown/PCU, med/surg ; From: US ; Joined: Oct '01; Posts: 1,352; Likes: 81I've seen Phenergan kill people and it sure does burn. I never start with 12.5 any more, but rather 6.25mg IV to begin with. Of course PO I'll do 12.5 no problem.
Feb 12, '07Occupation: Pediatric RN, ICU coordinator Specialty: 4 year(s) of experience in PICU, surgical post-op ; From: CA ; Joined: Dec '06; Posts: 424; Likes: 187I know the thread's about phenergan (which we don't use) but I do want to ask about the demerol issue ... We use it all the time. Especially on scoli surgeries ... the kiddos across the board come back with demerol PCAs. What's the issue / danger with demerol? I know sometimes it makes my kids forget to breathe now and again, but I've never had a major issue that can't be controlled with turning down the settings.
Feb 12, '07Occupation: Med/Surg RN Specialty: 14 year(s) of experience in Med/Surg, Perinatal, Float ; Joined: May '06; Posts: 105; Likes: 1We can only give phenergan supp. at my hosp. it works great and lasts longer, but the first line drugs are still zofran and inapsine.
Feb 12, '07Joined: Oct '06; Posts: 1,256; Likes: 66I emailed my manager regarding this, she's pretty good about forwarding it on to the proper person.
Feb 12, '07Joined: Sep '03; Posts: 6,885; Likes: 12,485Hospitals tend to change policies after a sentinel event. :stone
My hospital has no specific policy on Phenergan. It's used less than Zofran, Compazine & Reglan in my dept., but I do give it regularly, both 12.5mg & 25mg.
I personally will not push it except through a running line of saline, via a high port. Its potential problems first came to my attention here at allnurses.com. I learn something here all the time!
Feb 12, '07Joined: Jul '06; Posts: 557; Likes: 47Lordy, I am so glad I hae been giving phenergan in 25cc NSS for lots of years, a bunch of us just started mixing it and giving it this way because patients lots so many IV's and c/o pain/soreness to IV sites. Zofran is used more now but some of the older MD's still like to use phenergan and don't care how we give it, just so we do.
Feb 12, '07Occupation: ER Nurse Specialty: 2 year(s) of experience in ER ; Joined: Apr '06; Posts: 23; Likes: 1My hospital took Phenergan off formulary. The only way we can give it in the ER is IM. Zofran is now our first choice then Compazine, Reglan etc. The ambulance companies currently still carry it but that is to change too.