I am missing something obvious?

[missmollie]

Is there a reason why we would give a PO medication to a patient who is vomiting? I can understand giving that prescription to someone at home with no option but PO, but in the hospital when the patient has IV access...what am I missing?

[RobbiRN, RN]

Of course the IV route makes more sense if you have one, but Zofran can be given sublingual. You don't need to swallow anything else to "get it down," and you can wait a half hour or so before trying sips of liquid if symptoms resolve.

For the record, I have given IV Phenergan for 24 years and never had a problem. Given properly, in a good IV, in a good vein, in free-flowing saline, I still believe it's the best anti emetic out there. And they go to sleep. Yeah.

[Boomer MS, RN]

Of course the IV route makes more sense if you have one, but Zofran can be given sublingual. You don't need to swallow anything else to "get it down," and you can wait a half hour or so before trying sips of liquid if symptoms resolve.

For the record, I have given IV Phenergan for 24 years and never had a problem. Given properly, in a good IV, in a good vein, in free-flowing saline, I still believe it's the best anti emetic out there. And they go to sleep. Yeah.

Good to know that Zofran can be given sublingual! In my 10 years in the ED at four facilities, I never had a problem with IV Phenergan either, and it was my preferred anti emetic. But it received a black box warning a few years back, and its use was abandoned at many facilities. I felt if it was given correctly there would not be a problem, but the literature disagreed. The pictures I saw in a journal were devastating. I'm retired now, and maybe it has made a comeback. I've been around long enough to have used levophed, then to see it abandoned (called "leave 'em dead) and then to see a return to its use before I retired.

[Mavrick, BSN, RN]

We use Phenergan as a third line anti-emetic (Zofran and Reglan are the first two choices). Never had complications. Dilute 25mg in 9ml NS then give 6.25mg (2.5ml) in a swiftly running peripheral IV. It works and yeah they get a little snoozy.

[akulahawkRN, ADN, RN, EMT-P]

I've also given phenergan as a 3rd line anti-emetic by IV and it does work very well. You just have to be absolutely certain the line is good. It works quite well!

[whatdayisit11to7Nrse]

I would think IV would make more sense too though

[morte, LPN, LVN]

If you want sleepy, how abut diphenhyramine?

[DarkDiva]

If the med was phenergan, we're under a national shortage of IV. So says my workplace.

Huh, just had surgery 3 weeks ago and they gave me IV* phenegren after the zofran didn't cut it. As to the original post I don't see a PO med doing the patient much good if they're vomiting. That's probably something I would clarify with a fellow nurse first, but I'm a baby nurse and have only been working six months. Then depending what they said I would call the provider.

[ohiobobcat]

I have been a nurse for almost 11 years now. I started out using IV Phenergan. I never had a problem with it, but I also saw some of those devastating pictures of IV Phenergan gone bad. We switched to IV Zofran, Reglan and Compazine in the hospital sysatem I ued to work in about 3-4 years after I started working there as a new nurse. We used the Zofran ODT a lot, and would still give Phenergan PO and rx for Phenergan PO too. Our state medicaid would not cover the Zofran ODT, so that became a challenge to try and catch that before patients left to prevent a phone call for the pharmacy later (I worked in the ED).

[TheCommuter, BSN, RN]

What about Zofran or Reglan?

When I worked on the floor at a specialty hospital, the providers avoided prescribing Zofran because it is tremendously expensive.

[Boomer MS, RN]

When I worked on the floor at a specialty hospital, the providers avoided prescribing Zofran because it is tremendously expensive.

Very true when it was first introduced. There has been a generic, ondansetron, for some time.

[Meriwhen, ASN, BSN, MSN, RN]

We still use non-PO Phenergan, but IM and not IV. And because of it's potential to be irritating, the IM injection has to go in a large muscle such as a glute or thigh.

[oldpsychnurse]

to be honest i have never actually seen any oral antimetic medications. almost every pt has IV zofran or compazine

Psych patients pretty much always get po anti-emetics unless we see evidence of vomiting, and lots of it. A lot of them are addicts on top of all their other problems and for whatever reason a lot of them complain of n/v to get meds. I guess they think they'll get something that will give them a buzz. Also, a lot of them put their finger down their throats to self-induce, then demand an IV. They seem to be under the impression that an IV will automatically lead to IV opiates and benzos. And I'm not being accusatory towards my patients. I've just seen it over and over again, and we try to minimize their expectations of getting a hospital-induced high.