Help Phenergan & Picc Line????

DreamingTree · Jul 27, 2008

I'm new, so probably not the best source of info. However, from what I've looked up, you don't need to dilute phenergan (neither of my drug guides specify the need to do so). But, with a picc line, you do need to use a 10 mL syringe.

Our facility tends to include dilution instructions on the MAR. I just gave this med a couple weeks ago through a PICC, and I think the MAR did instruct me to dilute it, but I gave so many IV pushes on that pt that I don't trust my memory. When in doubt, ask the pharmacy or check your units reference guides.

Hopefully someone with more experience will answer for you!!

RiverNurse · Jul 27, 2008

Hi,

Phenergan is a vesicant. I dilute it with saline and give it with a free flowing IV as opposed to IV push. It can damage the veins and if there is extravasation, necrosis can occur. What is hoped for is dilution - for example a smaller catheter in a larger vein, administration through a central line for more dilution, etc.

I'm a newbie here, so if all I had was a saline lock, I'd probably call pharmacy to see what my options were - I'd call the doc if needed- (help me with my nursing judgement here... :-)). However, in my experience, most of my patients receiving phenergan have had primary IV fluids going and I usually dilute in 10 mL of saline as a rule.

HTH,

Shawna

Indy, LPN, LVN · Jul 28, 2008

There are a lot of threads on phenergan here. I would dilute with NS and give slowly. I know the tip of the PICC line is supposed to end in a larger vessel but why chance it, eh? Our pharmacy always gives us the option of getting out a 50ml bag of NS to do the phenergan piggyback. I use that if I don't have compatible fluids already infusing.

I do wonder about the material that the PICC is made of, will the acidity of the drug erode the catheter if repeated injections are done over time? This would probably be something the manufacturer would have to answer.

leslie :-D · Jul 28, 2008

you're going to find it varies from nurse to nurse.

even w/dilution, it does not decrease risk of phlebitis, but can reduce burning sensation.

and, knowing that cath tips can migrate, i err on the side of caution, dilute and give over at least 5 minutes.

50cc bags for infusion, are much more convenient.

but i still hate giving iv phenergan.

leslie

1_Dedicated_RN · Jul 28, 2008

Thanks I think I will continue to dilute it with 10 ml of normal saline Thanks for all of your comments

ibmaryann · Aug 2, 2008

At my hospital we are not allowed to give it IV only IM.

cutehumor · Aug 4, 2008

I always dilute with NS everytime. IV or PICC, just as a habit, plus for safety. gets you in a routine. You don't want to accidentally forget not to dilute for an IV if your swamped.

surferbettycrocker · Aug 4, 2008

questin: if the MOA of phenergan is: H1 blockade- how is this a vesicant? if PICC lines can be used for chemotherapeutic agents, wouldn't it be a little safer to run a vesicant through a PICC?

Indy, LPN, LVN · Aug 4, 2008

questin: if the MOA of phenergan is: H1 blockade- how is this a vesicant? if PICC lines can be used for chemotherapeutic agents, wouldn't it be a little safer to run a vesicant through a PICC?

The acidity is low even when diluted with NS. And due to just the acidity alone, I was wondering what it does to catheters if it's injected frequently. Obviously I know squat about chemo.

IVRUS, BSN, RN · Aug 4, 2008

questin: if the MOA of phenergan is: H1 blockade- how is this a vesicant? if PICC lines can be used for chemotherapeutic agents, wouldn't it be a little safer to run a vesicant through a PICC?

Just because phenergan competes with histamine for the H-1 receptors sites doesn't mean that it isn't harmful to the smooth endothelial cells lining the blood vessels. It is harmful and caustic and if the vessel breaks down allowing the permeability of this medication to go into the tissues, then this medication can cause tissue sloughing, tissue blistering and tissue necrosis or death. (Which is the exact definition of a vesicant!)

INS (Infusion Nurses Society) states that vesicant's should infuse via central venous catheters as you have a much greater blood flow in the SVC than you do in the peripheral vascular system. ( Blood flow in the SVC = approx. 2L/min).

So Yes, it would be much better to go via central IV catheter, like a PICC line.

nyemt195488 · Aug 5, 2008

I can't answer from a nursing standpoint, but I can from a patient standpoint. I have had 31 PICC lines mainly due to needing phenergan IV for gastroparesis. It did not need to be diluted for a PICC line, I just had to make sure I drew it up with a filter needle into a 10cc syringe and flushed it with atleast 5cc of NS before and 5cc after. It never burned or anything like that, but I can tell you that if you don't push it slowly the pt. will get very woozy feeling very quickly like in 2-3 seconds, almost like high. When I was very nauseated I would often not have my mind on pushing it slowly just on getting relief as fast as possible.