Protocol for admin. IV Phenergan

chip193 · Nov 26, 2004

OUCH!! I can't imagine being on the receiving end of undiluted IV Phenergan......all I know is I would never give it that way. Our protocol is to dilute with 9ml NS and give over at least 2 minutes; I give it more slowly than that, because I know how it burns and what it can do to a vein. In fact, I usually push it over 4-5 minutes; as a result, I've never had one single complaint about my administration of IV Phenergan, even when giving it through a saline lock. Nothing wrong with being cautious, and as busy as I get sometimes, I think it's worth taking the time to do IV push meds right so they don't cause more harm than they 'cure'.

We don't dilute it at our place. And I never diluted it in the field.

Chip

neneRN, BSN, RN · Nov 27, 2004

Our hospital policy just changed fairly recently that we have to dilute it in at least 50 cc NS...because there were too many incidents re phlebitis after nurses pushed it undiluted. I used to give it mixed in 10 cc NS over a minute and never had a problem. Did witness another nurse giving it undiluted through a 22 in the wrist- within seconds the pt had bright red streaks up the arm following the vessel path, screaming in pain. We gave her a NS bolus immediately, but the arm stayed red for a while. I think the policy saves the pts from the few nurses who don't have common sense...yea, you could probably push it undiluted into an AC, but into a 22 in the wrist? That's just ignorance.

webblarsk · Nov 29, 2004

I dilute with 9 cc and give slow push over 4-5 minutes. Never had a complaint of burning. Just complaints that the med won't work the same since it's going in so slow and that "the other nurses don't do it that way" :rolleyes:

CBER · Dec 2, 2004

The references I looked at states that phenergan can be given IV push diluted or not.Look at the infusion nurses society about the ph of drugs. Phenergan does not fall into a drug that is safe to push in a perioheral line. I just read an article where phenergan was blamed for the loss of an arm. I hope this helps. Also the reference I looked at stated it should be given through a running IV.Diluting the phenergan with any amount of ns does not change the ph of the drug.

I would like to know if anyone has the standard protocol for delivery of IV Phenergan. The hospital I work at says dilute with 10-20cc but I was just hospitalized myself ( it sucks to be the patient) and the nurse gave me IV Phenergan with only a 3cc dilution. I questioned her after she ruined my IV site ( and I got cellulitus) and she denied using a 3cc to the IV nurses. I would like to know what the standard protocol is. Thanks for your help!

chip193 · Dec 2, 2004

The references I looked at states that phenergan can be given IV push diluted or not.Look at the infusion nurses society about the ph of drugs. Phenergan does not fall into a drug that is safe to push in a perioheral line. I just read an article where phenergan was blamed for the loss of an arm. I hope this helps. Also the reference I looked at stated it should be given through a running IV.Diluting the phenergan with any amount of ns does not change the ph of the drug.

It will not change the pH of the medication itself, but diluting any drug in a large quantity of neutral solution (like NS) will bring the pH closer to neutral.

You can try this experiment at home. Take vinegar and add water to it. It will not be as acidic as when it is straight from the bottle. Same principle applied here.

Chip

CBER · Dec 3, 2004

The INS standards of practice reccomend that drugs have a ph of at least 5 and no more than 9. I talked with Baxter(owns phenergan now) and the ph of phenergan is 4-5.5. Yes we give it IVPush in the hospital I work in but that is an issue being delt with at the risk management level now. I just think there is a right way to do this and I am not sure what that is.There have been so many issues with this drug being given IV push. It is always best to be cautious in pt care. Gayle

actioncat · Dec 6, 2004

You dilute it even if you put it in a distal port? I sthis necessary. I never have when putting it in a distal port, but if it is necessary I will start doing it.

CBER · Dec 6, 2004

You need to see what the policy and procedure at your facility is. Giving it in a distal port is a great idea put diluting it would be an even better idea. Safer for the pt and for you. The references I have seen stated it can be given diluted or not. I choose to always dilute with at least 9 cc ns.

Gayle

You dilute it even if you put it in a distal port? I sthis necessary. I never have when putting it in a distal port, but if it is necessary I will start doing it.

IVRUS, BSN, RN · Dec 16, 2004

Phenergan is a vesicant, therefore if it isn't diluted and an extravasation occurs, it can cause tissue blistering, tissue sloughing or even tissue necrosis/death to that tissue. By diluting it, you decrease the amt given, thus decreasing the tissue damage if you notice edema &/or a patient c/o burning or discomfort with the IVP.

HACCGrad · Mar 2, 2008

Recently as a nursing student on med/surg floor I had to give phenergan. The protocol there was never to give IV push. To dilute it in a 50cc bag and give over 15 minutes.

rgroyer1RNBSN, BSN, RN · Mar 5, 2008

We give it as a Piggy back in 50 ML NS slow drip. or if I do have to push it we start with 12.5mgs in 10 of NS and then the other 12.5 if needed.

passion for infusion · Mar 19, 2008

phenergan can be given diluted or undiluted...if diluted concentration should not exceed 25mg/ml. However,there have been many case reports of extravastion with subsequent necrosis. There was even a lawsuit when it was inadvertantly given intraarterial instead if intravenous. Thank god our hospital does not allow it to be used intravenously anymore...it is automatically substituted with compazine. We kept reporting horrible incident such as painful phlebitis...cellulitis and extravastion...some drugs no matter how much you dilute are inherently irritating.. We just avoid the whole messy problem now