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.
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 like that idea, I think I'm going to start doing that. Perhaps I can get other nurses started on that as well. In my dpt we just give the phenergin IV push with a NS flush.
Yikes! I never give phenergan straight - always dilute it. Unfortunately, I can't seem to get this idea across to some of our other nurses and the vein becomes irritated and the phenergan burns even diluted. I have personal experience with phenergan burns - major phlebitis, luckily no thrombosis. I had several doses given without dilution in a wrist site and my arm was extremely sore and was red from the wrist to the antecubital area, about 3 inches across. I didn't realize how bad it was until I got up to go to the BR - had the lights dimmed in the room. Of course, I was blessed with an idiot nurse and told her I needed a new IV. She checked it for patency, blood return, and was going to leave it in :selfbonk: . I almost had to take it out myself to get it changed. It took a few weeks for all the redness and tenderness to resolve.
Well, I am happy to report that the warfarin does seem to be doing its job. The three areas of scleritis have just about disappeared and can barely be palpated. The superficial clot at the wrist that was pretty much a round bump is not quite so large and is more elongated than high and round. Of course, at this stage I have no idea how the DVT in the axiallary is doing but I'm going to assume there may have been some desirable changes there as well.
I've often thought the same thing . . . IV sites go bad and maybe it was just a coincidence that it hurt with the phenergan.
I give it all the time in the ER through the IV and no complaints . .. I also just gave 30 mg of Toradol IVP . . no complaints.
steph
Phenergan is a dangerous drug. It is a vesicant and I know personnaly of a patient that has had a finger amputated because the IV was leaking and the phenergan got into the tissue. Several years ago a patient eventually had hand amputated (was a law suit), the same thing. Unfortunatly, we don't heed warnings until a problem happens. Nurses need to be more proactive and not reactive.
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.
Sorry to hear about your awful experience. We are required to dilute phenergan and run over 10 minutes through a syringe pump. Sometimes it takes a story like yours to really believe the things that are recommended are recommended for a reason! Here's to diluting phenergan and giving slowly!
I can't believe that phenergan is given straight without dilution. My grandmother was in the hospital recently for a pretty bad ankle fracture and the nurse came in the room and gave her 6mg of morphine iv push, no dilution over about 2 seconds, of course the minute the nurse walked out of the room she became very nauseated and began vomiting. I walked out to the desk and requested something for her for nausea and the nurse returned with phenergan that was not diluted and went to push it straight into a heplock. I stopped her and questioned her as to whether she was going to dilute it and she looked at me like I was out of my mind. I know someone who got a PE after receiving phenergan undiluted which he developed a DVT from and eventually a PE. Dangerous drug, dilute and give slow!!!!
TO ALL NURSES giving IV push promethazine... it should be diluted with 10 MLs of normal saline..... i have heard of patients having to get thier arms amputated due to nurses pushing non-diluted promethazine ...... pure fact.
Information PLEASE! I have a similar problem, but is it in both arms and I can trace the vein from the IV site all the way up my arms. What causes this and what was done about it? Did you file a complaint with the facility and is this a serious problem? I had Sx ~3 wks ago and it has not gone away and the veins are very painful. When the veins branch, the secondary branches are also hard and I had to do lab work, and the veins are useless! They had to use a small vein instead, which hurt! PLEASE assist in this search for answers.
Well, I happen to volunteer at the hospital where I had the IV push of phenergan and Toradol and happen to casually know the nurse who administered the IV and he's a heck of a nice guy and to the best of my knowledge one heck of a good nurse. He had been great when my brother in law was rushed in by ambulance for an abdominal aortic aneurysm. So I did NOT want to cause him any real grief. What I did do was approach the head of the hospital pharmacy w/all the info I had gathered on the problems w/improper IV pushes of phenergan (and to a lesser degree) of Toradol, related my experience and my concerns and he assurred me they would reassess hospital policy regarding IV phenergan and Toradol.
As far as my own care, because of the superficial thrombophlebitis the hospital did do a doppler ultrasound, found the DVT in my left axiallary vein, admitted me, started treatment, released me 3 days later on coumadin for the next 6 months and continued followup w/my family doctor. The ER doctor at first didn't want to accept the "cause" of the DVT but I was quite firm about when, where and how the ST occurred, the admitting doctor concurred w/the cause and the hospital did swallow the hospitalization bill rather than billing my insurance.
Have you seen your family doctor about this? Are you using hot compresses on these veins? How old are you? If you are relatively young (I was 63) it might we a wise idea if your family doctor checks you for any genetic factor, such as Alpha-1 ???, that can predispose you to developing blood clots. Good luck and God bless!
Well, I am 33 and I had the phenergan with toradol also. I had the "push" in the ER and on the floor for 2 days. Noboby would listen to me about how much it hurt. Even the flushes hurt. I was hep-welled so there was no additional fluid going through to dilute it. I have told my Gyn Dr and she is running some blood work. Warm compresses are not even touching it. The pain is what is getting me. And the fact that the veins are now unable to be used. Were your veins affected all the way up your arms and did it branch with the vein? I had many more doses than you did, so there could be a difference there. Even in Sx I told them the anesthesia IV meds hurt and they said that it should not have. They started a new line in the other arm and when I went back up to the floor, the nurses put the phen/tor in that arm too. No body would listen for 2 days! My friend said when they did the patency flush, she thought I was going to come off the bed since it was so painful. I just do not know what to do. I can not remeber whether they diluted the meds or not because of the on going doses of the medication. I do not even remember telling them that I was having nausea! What do you think?
Rnannie94
23 Posts