How do you dilute IV push phenergan?

[eastsider]

Our IV phenergan comes in 25 mg/ml vials.  It is typically ordered as 6.25 mg IV push, I.e. 0.25 ml.  How does everyone here draw that up on the floor? Typically, I'll use a 1ml syringe, draw up 0.25ml, and then, using the same blunt fill needle I drew up with, push the medication into a 10ml syringe containing my NS diluent (8-10ml).  I've also seen people pull up the whole 25mg (1ml) of medication into exactly 9ml NS in a 10ml syringe, and then waste 7.5ml to get to the 6.25mg in 2.5ml.  I see INS recommendations that discourage transferring meds from one syringe to another, but often times you require both a higher volume (I.e. 10ml) and a finer degree of measurement accuracy (I.e. 0.25ml), and no single syringe meets both of these requirements.  What's your practice?

[Sour Lemon]

1 hour ago, eastsider said:

Our IV phenergan comes in 25 mg/ml vials.  It is typically ordered as 6.25 mg IV push, I.e. 0.25 ml.  How does everyone here draw that up on the floor? Typically, I'll use a 1ml syringe, draw up 0.25ml, and then, using the same blunt fill needle I drew up with, push the medication into a 10ml syringe containing my NS diluent (8-10ml).  I've also seen people pull up the whole 25mg (1ml) of medication into exactly 9ml NS in a 10ml syringe, and then waste 7.5ml to get to the 6.25mg in 2.5ml.  I see INS recommendations that discourage transferring meds from one syringe to another, but often times you require both a higher volume (I.e. 10ml) and a finer degree of measurement accuracy (I.e. 0.25ml), and no single syringe meets both of these requirements.  What's your practice?

I used to do it the same way you do when I worked at a hospital that stocked it.

[TheMoonisMyLantern, ADN, LPN, RN]

The second method you mentioned seems weird to me. I would be concerned that 2.5mL total amount wouldn't be dilute enough for Phenergan, even if it is a low dose. I would stick with what you're currently doing, that's how I used to do it until the hospitals around here went to using Phenergan in IVPB only.

[registerednutrn, BSN, RN]

It should be diluted in 25 ml of NS and given over 15 min ivpb not ivp .  My understanding is that the IV form is no longer made.  None of the hospitals here have it anymore all we get is the pills, suppository, or the cream you put on the wrist. I sure hated when we quit getting the IV  stuff because it work so well.

 

[Tweety, BSN, RN]

20 minutes ago, registerednutrn said:

It should be diluted in 25 ml of NS and given over 15 min ivpb not ivp .  My understanding is that the IV form is no longer made.  None of the hospitals here have it anymore all we get is the pills, suppository, or the cream you put on the wrist. I sure hated when we quit getting the IV  stuff because it work so well.

 

It's still used where I work but the pharmacy makes the bags for us as we need them.   Very rarely is it ordered.  I remember back in the day using it IV on all the posts and was fortunate to never have an issue the many hundreds of times I've pushed it.

 

[AggieNurse99, BSN, RN]

I don’t like to give IVP phenergan in a peripheral IV - you must treat it like any other dangerous vesicant - and our policy on IVP vesicants has us using the side port of a free flowing (ie gravity) primary set.  ISMP has a lot on the subject http://patientsafety.pa.gov/ADVISORIES/documents/200703_07.pdf ISMP also highlights the dangers of using prefilled flushes to dilute meds. https://www.pharmacytimes.com/publications/issue/2018/october2018/an-unsafe-practice-reuse-of-prefilled-saline-flush-

I’d draw 0.25 ml up in a 1cc syringe and then slowly inject into a primary as above over at least 2 minutes. Alternatively I’d ask pharmacy to prepare it in a 50 ml piggyback. Also I routinely suggest phenergan suppository and IM phenergan due to extravasation risk if the patient does not have a central line or port. IVP phenergan is a very dangerous practice outside of the standard of care.