Morphine/Phnergan IVP...to give or not to give?

netglow, ASN, RN · May 25, 2011

Sounds like a burnt doc. The nurses are practitioners who still care and feel responsible for their practice.

HTXRN11 · May 25, 2011

That's what my thoughts were but this incident has caused so much controversy that I wanted another perspective but that's exactly what I thought..thanks!

MunoRN, RN · May 25, 2011

Promethazine potentiates morphine, which makes it a popular combo with recreational users, but can also be useful for therapeutic purposes aside from just treating opiate associated nausea. Supposedly it potentiates mainly the sedating and euphoric effects of morphine, which can be useful for those patients who "go crazy" after getting morphine and could use a little sedation and something to help put them in their 'happy place', (or at least some 'place' where imaginary birds aren't attacking them).

The down side, along with potential for abusive use, is that it's a vesicant and it carries it's own sedating properties which can't be as easily reversed as those of morphine.

HTXRN11 · May 25, 2011

Make sense as to why Everytime he sees the doc he's asking for and increase in the frequency and dosage..the pt can hardly stay awake..but some how know the exact time he's suppose to get his next dose..I personally think this is more harmful then helpful to him.....

Sonjailana · May 25, 2011

Just say No. Seriously, if a pt had a peripheral IV, I would NOT push phenergan undiluted. Can you say extravasation? I have no problem telling a pt, "that's fine that the other nurses did it such and such way, I'm doing it this way." Do what's best for the pt, not necessarily what they want. So what if they 'fire' you. It'll be a calmer day afterward :)

brownbook · May 25, 2011

None of us is going to fix this patient's drug addiction or personality disorder. He has been getting this combination for some time now? He knows what he wants, when he wants it, how he wants it.

If your concern is respiratory depression, overdosing, that may be a legitimate issue. If the concern is he is a drug addicted idiot, as I said we can't fix that.

Unless you are working in a drug rehab facility, give the patient what he wants.

Sun0408, ASN, RN · May 25, 2011

I have no problem giving him both drugs together; however, I will not give phenergan IVP undiluted. CYA

FancypantsRN · May 25, 2011

I agree about the not fixing the addiction part.... not our job unless we work drug rehab. I will give them what they want if the doc orders it - but how I give it? I would have a problem with the no dilution order, and I would just tell the doc I don't feel comfortable with that. The dilution part (in my opinion) should not be the solution to if the dosage/freq needs to be addressed. So I would not give it undiluted (esp the phenergen). At a couple of facilities I have worked at we were not even allowed to give it IVP (had to be in a 50 cc bag mixed by pharmacy).

classicdame, MSN, EdD · May 25, 2011

Our facility has a policy against administering Phenergan IV push. It can only be given in a minimum of 50 cc. dilution over a minimum of 10 minutes (depending on pts. age, fluid status, etc). We are not allowed to push it at all. I believe there is evidence showing that phenergan, which is a vesicant drug, can damage veins if given by push. The drug also comes PO/PR and even topical.

ChristineN, BSN, RN · May 25, 2011

At my hospital we aren't even allowed to give Phenergan undiluted. We are required to dilute it in at least 50ml of NS and give on a pump over at least 15 min.

And I never give Morphine or other narcs undiluted. Even if I'm just pushing it I will mix it in a 10cc NS syringe.

GooeyRN, ADN, BSN, CNA, LPN, RN · May 25, 2011

I won't give phenergan undiluted. It is too hard on the veins.