Phenergan IV changes in policy

  1. 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.
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  3. by   CritterLover
    yes, our hospital system recently made similar changes. plus, it cannot be given through a hand or wrist iv.
    [color=#483d8b]there is actually a very lengthy, old thread on this very subject. i'll see if i can find it.
    [color=#483d8b]phenergan is a vesicant, and it is against ins guidelines to give it iv through a peripheral line. i tried to get my hospital's policy changed, but didn't have any luck. what changed was when ismp's newsletter came out showing the tissue necrosis effects phenergan can have. that is when we finally saw policy changes.
    [color=#483d8b]when i worked in the sicu, we had a pt with severe nerve damage caused by phenergan/demerol that had been pushed through a piv that had inadvertantly been placed in an artery. he had undergone some sort of nerve block in an attempt to control his pain. very ugly.
  4. by   jo272wv
    The surgincal dept at my hospital has already done away with IV phenergan and switched to zofran. Family practice and internal medicine are a little slower at changing. Zofran seems to achieve the same results without the sedative effect and the burning when given. I think this was a good move and cuts down on the aggrivation when the drug seeking pt asks for their pain and nausea medications together. I still do not give both zofran and pain meds at the same time though, even with zofran.
  5. by   TazziRN
    But what if Zofran doesn't work? I had a horrible time with morphine after surgery and the staff tried everything.....Zofran, Reglan, Compazine.....PACU doesn't have droperidol anymore so I got Phenergan, and it worked.

    We don't have a Phenergan policy, but my own practice is to dilute it somehow....either in a syringe with NS, or I inject it in to the IV bag hanging and run a few mls in wide open.
  6. by   CritterLover
    ok, those threads are more difficult to find than i thought they'd be.

    here are a few, i'm not sure if i've found the one i was looking for. i seem to remember that it started in 2001 or so, but spanned several years.
  7. by   P_RN
    I had surgery in Sept 06. I STILL have a ropey phlebitits in my right arm about 10" long from IV Demerol and Phenergan. I think that's plenty reason to do away with peripheral Phenergan.
  8. by   meandragonbrett
    We give 6.25mg diluted in 10cc NS and then give 12.5mg in 30 minutes if the 6.25 did not help. We did away with Demerol for all of the obvious reasons.
  9. by   GardenDove
    The latest issue of Nursing 2007 has an informative article about this. I was unaware that this was such a risky med. My hospital doesn't have any restrictions, but I'm going to bring the article to my manager's attention.
  10. by   Spidey's mom
    We give it all the time usually starting at 12.5 mg and have never had a problem. I've never had anyone complain of it burning either.

  11. by   TigerGalLE
    Does giving phenergan IM cause these same problems?
  12. by   Spidey's mom
    Quote from TigerGalLE
    Does giving phenergan IM cause these same problems?

    No, that is the preferred way of giving it . . . .

  13. by   TigerGalLE
    and with demerol... IM and PO only... IVP no longer preferred? correct?

    I'm a new nurse.. trying to learn
  14. by   Spidey's mom
    Quote from TigerGalLE
    and with demerol... IM and PO only... IVP no longer preferred? correct?

    I'm a new nurse.. trying to learn
    Just depends on where you are . . . . I give IV Demerol too.