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.
Yes, Toradol burns, I've also been on the receiving end and had pt's tell me it burns. I also dilute the Toradol with NSS before giving it. Maybe the combination of two very irritating drugs made you even more predisposed to DVT. We don't use Phenergan very much but when it's ordered IV it is diluted.
We use a lot of Reglan and Zofran. I've found Reglan can cause people to get very anxious sometimes. Anyone else had this happen?
I agree that phenergain iv is a nasty drug so I always dilute it with 10ml of NS before giving it either through a saline lock or an IV with fluids running. I also give it very slowly. I haven't had anyone tell me it caused burning using this method, and I don't know of anyone who has developed complications (of course, I work in the ER, and mostly we never hear what happens after patients leave us).
Toradol can not be mixed with any other medications. Is there a possibility that this happened? That the meds could have been given too close together without enough flush between them? Just a thought.
Good luck on your recovery.
Four pages of replies about bad ol' phenergan and one reply addressing another possible cause of the DVT. Toradol is a great drug, but can get quite nasty when mixed in line with other drugs and precipitates out of solution and into a crystallate. I do not know of any studies to this effect but injecting the precipitate into the vein seems like a possible culprit.
Four pages of replies about bad ol' phenergan and one reply addressing a more likely cause of the DVT. Toradol is a great drug, but can get quite nasty when mixed in line with other drugs and precipitates out of solution and into a crystallate. This scenario sounds far more likely than strickly phenergan as the culprit
Thank you, MATurner. I have no true idea if both were given in the same syringe or not. My memory says one syringe, one push, no flush, just the fluids coming down from further up the line, but I'm a lay person, it was 2 months ago and my nurse at the time said it was the phenergan. I question the toradol as well simply because phenergan has never been a problem for me before and I've had it so many times albeit always further up the line or even via a bag of fluids or as an IM injection. The matter has been brought up to the "powers that be" at our hospital and current proctocols are being re-considered.
I would also like to thank all of the kind and caring nurses who have taken the time to respond to my questions about this. Hopefully, these replies and my experience will inspire a change in protocol and even better care at our hospital and ED in the future.
I was surprised to learn that toradol is an injectable NSAID. It would seem to me that it would therefore be contraindicated in a patient known to have Crohn's disease. I'm surprised that the ER doctor would have even scripted its one time use for me given my 30 year history of Crohn's. I don't seem to have encountered any problems from that IV injection of it but I don't know that I would be comfortable about letting them give it to me in the future. What are your thoughts on its use in a Crohn's patient?
As a nurse with a 16 year history of ulcerative colitis, and being prone to GI bleeds, I've used Toradol many times with no problem.
In fact when the disease started to cause serious joint pain and problems, I have used toradol or ibuprofen for it. Narcotics tend to have more side effects and merely cover the pain, NSAIDs (with their anti-inflammatory effect) actually provide more comfort by relieving the inflammation without the sedation. They also reduce the fevers that accompany inflammatory exacerbations.
I would rather use NSAIDs than steriods for the joint inflammatory attacks, if they are adequate. Because the GI irritation and general side effects of prednisone are much worse than toradol or ibuprofen.
I will say that I could not tolerate vioxx or celebrex, because they did give me gut problems. I am also anaphylactically allergic to tylenol, so I have always had to use alternate OTCs.
Really, in an ER, Toradol is a pretty good choice as a pain reliever. It does not sedate the patient, so that they can drive themselves if need be. It relieves pain and inflammation. It has few dire side effects (unlike narcs). And in ERs, which are frequently besieged with med seekers and people that use narcs inappropriately, it avoid them being a supplier. And as a general rule, unless you have a long history with the physician where he "knows" your pain issues, it is a very safe option to giving narcs, especially for just the limited dosing that is done in the ER, before they can get in touch with your PCP.
You might review this issue with your PCP and make him aware of the issue so that he could leave a notation in your chart of the meds that he prefers used with your case.
I am a nurse in an icu, i had my gallbladder out a few years back and HATE toradol IV, it burns sooo much! I would with it a lot as an antiinflammatory, but give it really slow because many many patients c/o about the burn. It needs to be given very slow and mare sure patient is aware of the impending sensation.
I have got to reply to this one!!!! I hope the moron giving you the push did not just push it with out diluting it first. Phenergan should ALWAYS be diluted with like 10cc of normal saline and never pushed (regardless of site of PIV). I've had it IV as well and it burns like fire in your veins, even diluted. I think the key is education. Somewhere along the way you learn these things but it may not be in nursing school. I use toradol often in my IVIG pt's in an infusion suite. They would not do with out it and don't complain much of burning but then again I dilute and push slowly. I don't know what the literature says on this in particular but I know I've never had a pt complain about pain from toradol. I am also a frequent patient so I don't want to see us not use IV phenergan either but we've got to learn about our drugs before we go about randomly giving them. Hope you are doing better...tf
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.
As with many of the IV medications we give, there are issues dealing with ph and Osmolarity of the medication. I am curious if the nurse mixed the phenergan with the Toradol. Toradol will precipitate when mixed with just about anything but saline. I have been giving IV pheneragan in the ER for as long as I can remember. There is an old addage that will work with phenergan as well many other drugs. A wise old instructor once whispered to me "DILUTION IS THE SOLUTION!!!!!" Except with Valium of course....
I am a relatively new nurse- just got my license last November but the first time I had to push phenergan, I remember being told by the veterans that were training me to make sure it was diluted and pushed slowly because it burns, the other ones I have heard about are IV Kcl and Dilantin, had not heard about the demerol. Now, I usually run in with a NS after diluting in the syringe or dilute it to push it through a lock. I have not had any pt complain yet but I am sure there is someone out there who will be more sensitive and require a new way of doing things....
:Melody:
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.
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.
Unfortunately, our hospital still administers Phenergan IV and of course we have seen some poor outcomes. The positive thing that happened from this is at least we have to dilute it with 10 cc saline so the concentration is a little better. Hopefully this drug with go away like Dilantin which has the pH of battery acid.
I used to push Phenergan through the upper ports slowly no problem with
c/o pain. Earlier this year I went to a symposium on IV's. What I learned was that Phenergan should never be given in a lower port, the dosage should never exceed 12.5mg and it should always be diluted with at least 5 cc of NS. I learned that it can indeed cause DVT of the arm. If rarely a physician orders 25mg and I think the patient really needs it, I mix it in a 25cc PB and hang it over 15 minutes. It's a bit of a pain but it's what I would want my nurse to do for me. Patient safety and my sanity are worth everything!
camay1221_RN
324 Posts
Toradol burns!!!
I've been on the receiving end of it!