Just thought I would bring a recent experience up for discussion:
29 May I end up in ER w/24 hours of extreme chills (long sleeve T-shirt, PJs, 2 blankets, quilt and down sleeping bag), intermittent, transient bone and joint pain, nausea and vomiting. I was given an IV set near the base of the thumb for fluids and then an IV "push" of phenergan and toradol at the site of the IV set rather than up the line where it would have been somewhat diluted. As a 30 year Crohn's disease patient I have had PLENTY of IV and IM phenergan and demerol w/o any discomfort or problems. But this one BURNED and HURT! The nurse continued the "push" and explained that it was the phenergan. I didn't really believe this given my previous experiences and assumed it was really the toradol as that was my first experience with it. The pain and burning only lasted a few minutes after the "push".
I had no swelling of the hand or arm, no pain, no redness for several days. Long enough that I never even thought of the IV push when I began with a bruised type feeling on the inside of the arm just above the wrist and the outside of the arm 1/2 below the elbow. Several days after that I did notice a hard stretch of vein about 3/4" long 1/2 way below the elbow on the outside of the arm. Later a "bump" at the wrist, still later another 3/4" hard stretch of vein just above and a little to the outside of the bump. And then a 1/2" hard spot in the vein below the base of the thumb at the wrist. It finally occured to me that this was probably the result of the IV push but since there was no redness, no swelling, no tenderness unless I kept poking the areas I didn't bother seeing a doctor about it. (Heaven knows I see him enough as it is, bless his heart!).
21 July the "bump" at the wrist turned red and was tender. Hot compresses did nothing for it that evening nor the next morning. My family doctor isn't in the office on Fridays and I figured the ER IV push was the cause so I went to ER. I was told it was "just" superficial thrombophlebits that could take as much as 6 months to resolve and was about to be released (which was ok with me as long as the doctors weren't concerned). But the "lead" ER doctor came in, first time I had seen her, and she said she would feel more comfortable ordering a venous ultrasound before I was released as she had had 2 STs go "sour" on her in the previous 3 months. I didn't have a problem with that so of course I agreed. What the heck, she was the doctor.
Ha! Turns out I had a deep vein thrombosis in the axillary vein in that upper arm! You could have floored me!! I ended up being admitted and given IV heparin drip and oral coumadin. Upon release 3 days later I had to agree to daily blood draws which was a cheap price to pay to be released from the hospital since I didn't feel sick and didnt hurt.
I've since been reading up on STs and DVT and realize my part in letting things go so far. However, I've found quite a bit of controversey on IV phenergan (and also demerol). The Infusion Nurses Society Standard # 43 specifically states phenergan should NOT be given IV due to its PH and potential for harm.
Frankly, given my experience thru the years and the blessing that IV and IM phenergan (and demerol) has been I would hate to see its use be discontinued. However, this was the first and only time phenergan was ever administered IV that close to the IV set instead of up the line where it gets diluted w/the IV fluids.
I'd be interested in your thoughts and experiences on this event and the use and method of administering IV phenergan. Mind you, my mother worked at this hospital all the while I was growing up, other than Mayo Clinic it is the only hospital I have ever gone to (altho we have another in town) and I've been volunteering here for several years in Endoscopy or Messenger Service. I'm not looking to cause any trouble and I know my ER nurse from previous encounters in the cafeteria and elsewhere at the hospital and he is a fine and conscientious nurse. He was marvelous when my brother in law was brought in with an AAA.
