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.
Kedarradar, your instincts, education and training caused you to flush after both doses of phenergan. Your concern caused you to pursue information and to go to great lengths to educate yourself and your supervisors. MOST cases of insufficiently diluted IV phenergran that DO cause problems cause "only" some discomfort and pain for a few days. Very few end up causing serious problems such as that amputation. A CARING medical professional is such a VALUABLE "commodity" please stop beating yourself up over this. I certainly bear my ER nurse no ill will for what happened to me. He was genuinely concerned about my pain and suffering which caused the ER visit. Hopefully your actions will result in protocols being established at your hospital so that it doesn't happen again to another patient. The IV phenergan has been a blessing to me so many times thru the years during a Crohn's flare and obstruction that frankly, I don't want to see its use ended. I'm usually given demerol as well and given the incident I related I would prefer NOT to be given IV Toradol ever again and I most certainly would NEVER accept it orally due to my Crohn's. You are human, learn from your mistakes and continue CARING about and for your patients and you will always be a blessing to them.
Wow, how come the patients are always tougher than the nurses? I hope you're right and the odds are on my patient's side, my side. Good point about needing a specific drug that works for you, it's easy to take that for granted until you're the one in the bed. All I had was a tonsillectomy last July and I just kept being surprised how cool all the nurses were. They all were different and had different things to offer to help me get well. One just kept talking to me like she wanted to be my friend, the other put my IV in, the other kept offering me pain meds ("Would you like some dilaudid? she asked, "No, that won't be necessary", I said, already profoundly comfortable in my warm blankets) I never even saw the doc, only in his office before and after for about 5-10 minutes each time. I know that's nothing, but all that means something when you feel really bad. Just rambling, but thanks, it means a lot to hear that kind of thing from the other side of it.
I have worked at several facilities who ban the administration of IV Phenergan at a perf. site outside of the AC. And at one such that banned IV administration outright.
I would check this facilities policies for a smilair one. And I do support administering in diluted and into an IV bag's running IV line slowly.
Some poor lady in this story lost her hand due to IV push Phenergan and now the Supreme court will decide if courts or the FDA can put warning label on drugs. Very interesting
Some poor lady in this story lost her hand due to IV push Phenergan and now the Supreme court will decide if courts or the FDA can put warning label on drugs. Very interesting
Our hospital policy states that phenergan can no longer be pushed. We must dilute it in at least 50ml and run over 30min. Because of this we don't use much phenergan, but I think it works better and longer this way. We are using tons of Zofran. This is the first I've heard about the Toradol burning, I will pay more attention to my pts reaction. I've pretty much learned over the years that unless I'm in a code situation I dilute everything!
I practice the same way. Everything is given either in a mini bag and dripped in, or at the farthest port from the pt, slowly. I'll give morphine or dilaudid at the closest port, but not tordol.
I am a disabled retired Navy Nurse. I have worked in the medical field for over 22 years and had many charge nurse & supervisory responsibilities. Currently, I am in a Nashville, TN. Hospital where I have been given both IV Toradol & Morphine. Several times in the last 18 hours, 2 RN's and the Anesthesia Department have pushed these meds in without diluting them. They burned like fire, turned my skin red and started making the surrounding skin itch like crazy. One of my IV sights infiltrated because of this action. The distal skin became extremely tender and puffy. The RN wanted to argue with me, and that's when I finally had to tell her that I was a RN as well. When she discontinued the infiltrated site I asked her to please be kinder and gentler on the skin and not just yank the posite and tape off. When a second RN gave me IVP Morphine and Toradol into my vein without diluting it, I had, had it. I told her that if she diluted it and or pushed it more slowly with the IV Fluids then it would not cause the patient unnessary pain. My suggestion was that they needed retraining on how to administar IVP Meds. I plan to
write the Nursiing Director letter upon my discharge and explain how I was taken care
of I am sick and tired of bad nursing care and attitudes in hospitals today!!! Someone needs to be held accountable•••••••
I know this is an older threat, but i agree with you totally RLDunnBSNRetiredNavy. I see many nurses push medications quickly and cause pain with the patients, and if the patients complain, they roll their eyes and then the nurses complain about the patient during handover labelling them as 'difficult'!
I was always taught to go slow - i had a preceptor teach me to sing a song (preferably in my head!) to help me keep the time to around 3 minutes, which is the average recommended time for many medications.
I agree there seems to be a lack of attitude these days....
I too have been given phenergan IVP and it took 2 weeks for the bruising, redness and soreness to resolve. I had a red streak that went from the IV insertion site to my AC. I would never take that medication again. I have had on a few occasions to give the medication and have diluted it in 10mg of NS, which made the infusion more comfortable for the patient. (careful giving dexamethasone too, causes burning at the insertion site and that hot flash feeling for the patient...diluting it too gives a better result for the patient.
I think sometimes we have to go through things ourselves and be a patient in the ED to realize and believe what are patients are telling us and not just think of what your medication admin protocol says. If the patient has a complaint after med admin, believe him/her.
Glad things are now okay with you and now you know right...
I have given and been given compazine in the past and had the pleasure of experiencing the wonderful side effects or shall I say extrapyramidal effects of this medication. So much that I was given several milligrams of ativan to ward off the effects. I always would mix the compazine in a 50 to 100ml bag of normal saline. I was recently told by one of the attendings in the ED that giving the medication via infusion too long will decrease the effects of the compazine. I will be doing a little research on this comment but wondered if anyone else has had an expereince with this medication and what you think.
CrohnieToo
165 Posts
Kedarradar, your instincts, education and training caused you to flush after both doses of phenergan. Your concern caused you to pursue information and to go to great lengths to educate yourself and your supervisors. MOST cases of insufficiently diluted IV phenergran that DO cause problems cause "only" some discomfort and pain for a few days. Very few end up causing serious problems such as that amputation. A CARING medical professional is such a VALUABLE "commodity" please stop beating yourself up over this. I certainly bear my ER nurse no ill will for what happened to me. He was genuinely concerned about my pain and suffering which caused the ER visit. Hopefully your actions will result in protocols being established at your hospital so that it doesn't happen again to another patient. The IV phenergan has been a blessing to me so many times thru the years during a Crohn's flare and obstruction that frankly, I don't want to see its use ended. I'm usually given demerol as well and given the incident I related I would prefer NOT to be given IV Toradol ever again and I most certainly would NEVER accept it orally due to my Crohn's. You are human, learn from your mistakes and continue CARING about and for your patients and you will always be a blessing to them.