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50 mg of Phenergan IV push!!!!!!!!!

Posted

Specializes in Surgical.

Poor patient I had last night, he has been receiving this dose along with 75 mg of demerol q 4 hours for about a week...his poor veins!!!:eek: Do you guys give this much phenergan long term? I had to restart his site and his veins are a mess now with the frequent site changes and administration of this med. Just wondering if you guys did this often?:confused:

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

This poor patient is getting Demerol *and* Phenergan in those doses IV??! For *how* long??! OUCH!! For one thing, he needs a central line or PICC for IV therapy if he's going to need it for more than a week or 10 days; for another, he needs another form of pain relief. Please speak with his doctor about changing it.......I'm surprised he has any veins left after a week of this!:eek:

LilgirlRN, ADN, RN

Specializes in ED staff.

I would put the phenergan in a soluset , piggyback, buretrol or however you want to dilute it.

meownsmile, BSN, RN

Specializes in Med/Surg, Ortho.

I would think the Dem/Phen should be IM if he is getting it every 4 hours, we would use that as an IM schedule. I would expect the patient to need it every 4 hours if they are getting it IV. The half life of an IV med is shorter than IM therfore the dose isnt going to last the 4 hours. I would ask Dr to either put him on a PCA with a prn dose of zofran or soemthing,, or ask him to change the route. Most IV doses ive seen are either q1 or q2 hours, and are prn. I dont know what kind of surgery/illness this is being given for but some questions need to be asked if he is requiring it that often. Both for the nurses convience and the patients. Its not fair to the patient to have to ask for pain med q4 hours round the clock when we have PCA's available.

Now that i think about it, we rarely give 75 IV and 100mg doses are usually only given as preop after they go to holding, and they sure arent given for a week.

RN-PA, RN

Specializes in Med-Surg, Long Term Care.

I've only seen that order on our med-surg floor for IM Demerol and Phenergan-- NEVER IV. We're not allowed to give any more than Demerol 25 mg IV push on our floor at a time anyway.

nursenatalie, ADN, RN

Specializes in Surgical.

This patient had a crushed patella repaired with a muscle flap graft. He weighs about 400 pounds, he will be having a roux en y in three months, so I'll see him again then. Anyway he had been on a morphine PCA and graduated to the demerol. He had some complications with his graft and this was the reason for his extended stay. We have a pain management MD who is usually consulted but this guy obviously fell through the cracks. When I went back to work two nights later he had been discharged so they had eventually weaned him to po meds!

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

He graduated from Morphine to Demerol? What about Dilaudid?

Demerol- yuck.

Demerol and Phenergan, you'd almost have to mix them in 100cc and hang them like an antibiotic.

We have great luck with Tylenol 1G Q6H to decrease narcotic needs, or a scheduled antiinflammatory.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

I usually dilute demerol and phenergan with about 10 cc's.

But 50 mg of phenergan is too much to give IV. I don't have a resouce but isn't the max recommended dose for IV only 25?

As stated earlier this should be diluted in 100 cc of NSS and given as a PB over hour.

This patient should have a PCA. He should be on a antiinflamatory agent. Most of the ortho doc's here give Toradol IM in the PAC unit and give 2 more doses IM every 8 hours, this help with inflamation.

Why is this guy not getting po pain meds for break through pain. A crushed patella IS painful, seems like a pain management specialist should be called for some input.

nursenatalie, ADN, RN

Specializes in Surgical.

Patient was receiving scheduled Toradol...no doubt the inappropriate dosing/drugs used here...dont think 1 gm of Tylenol would help his pain much...dont matter how often or much. If I take orders from a doc for anti-emetic I always discourage them from ordering Phenergan (prefer Zofran, reglan, anzemet) Some docs seem to order it more often defiantly...we have some old school docs around who dont realize Demerol is NOT a good pain med.

Unless used for sedation, the maximum recommended amount for phenergan via the IV route is 25 mg. I've had enough experience to know that 25 mg IV can knock a person into la la land for a good long time, depress their respiratory and other generally unpleasant things. It's useless as a pain medication, it does not "potentiate" anything... all it does is sedate the patient and prevent them from being able to receive any other narcotic pain reliever, again due to it's sedative effect.

IM is not a route to be used for routine pain medications as it is generally unreliable with regards to absorption.

I would think a long acting oral medication, along with an antiinflammatory and possibly a second shorter acting narcotic for breakthrough pain would be preferable to IV medication... definitely preferable to IM anything.

Good for you to notice how inappropriate this order is, not to mention painful for the patient! ;)

(btw... I was thinking exactly what you were, Canoehead..."graduated from morphine to demerol" :confused: )

zacarias, ASN, RN

Specializes in tele, stepdown/PCU, med/surg. Has 14 years experience.

I had a neurosurgery patient a while back that had an infected VP shunt and was getting 150mg Demerol q 2!!!!!!!!!!!!!!!!!!!!!! I mean count the like 50 things wrong with this picture :\

TinyNurse, RN

Specializes in Emergency.

my research says phenergan 50 IV is for sedation purposes, although it can be given IM 50mg for other purposes. i can't imagine giving that q4 through an IV. poor thing.

zofran is my favorite, seems like it works every time, but i hear it is very expensive.

I agree with the other poster that said to hang the 50mg phenergan in a bag piggyback.

thanks for allowing me to do some research, hope you find your answer,i know i've learned something. xoxo Jen

babynurselsa, RN

Specializes in ER, NICU, NSY and some other stuff. Has 12 years experience.

We NEVER NEVER NEVER give Phenergan IV here. One of the hospitals I worked ER at had a massive lawsuit with a lady who lost 2 fingers, part of her hand and much tissue loss from the forearm. I tooke care of her later as an ER patient also so I know she is not a myth. Seeing the damage that this woman sustained made me understand why Phenergan in an IM only medication.

nursenatalie, ADN, RN

Specializes in Surgical.

By graduate I meant that the doc had ordered morphine for a couple days and then Demerol...no other implications~okay?

(btw... I was thinking exactly what you were, Canoehead..."graduated from morphine to demerol" :confused: )

bellehill, RN

Specializes in Neuro Critical Care. Has 9 years experience.

nursenatalie...funny that when I worked in NC that was the pain control choice-Demerol and Phenergan. I haven't given Demerol in the 2 years that I have been gone. Thanks for the trip down memory lane!!! Things never change in good ol' NC.

webbiedebbie

Specializes in OB, Telephone Triage, Chart Review/Code. Has 22 years experience.

Had a pt with crappy veins who was getting 25 mg Phenergan q 6 hrs. Even diluted, it about killed her with the pain. Anyway, she refused any more and we had to restart the IV because everything else was giving her pain through the IV. Called the MD and he okayed Phenergan supp.

I'm surprised at how the hospital nracotic protocols differ from place to place.I

know that no more than 50 mg demerol is pushed and if the doctor orders 75 mg iv, its piggybacked. 25 mg seems to be too small a dose to do anything. My 2 cents. :) I'm no nurse yet but that's what my friends tell me and my experience. Anyone have experience with Gravol IV? THAT burns :uhoh3: !!!!!!!!!

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