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

Long Term Care Columnist / Guide · Dec 20, 2003

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 · Dec 20, 2003

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

meownsmile, BSN, RN · Dec 21, 2003

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 · Dec 22, 2003

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 · Dec 23, 2003

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** · Dec 23, 2003

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 · Jan 1, 2004

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?

barefootlady, ADN, RN · Jan 3, 2004

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 · Jan 19, 2004

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.

Fgr8Out · Jan 20, 2004

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 · Mar 30, 2004

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 :\