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

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Hi, I was wondering what others thought on this at an hospital (LTAC)..There was a pt on med/surg floor who often requested from his MD..for the nurses to give him Morphine and Phenergan IVP undiluted and would often pitch fits is this drug was not given to him precisely that way...and yes there was an order to give it that way but it some nurses refused to do so..just wondering what everyone else's thought were on this thanks.

Specializes in Emergency.
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 :)

It is a lot easier at my hospital.. Per policy we can only give phenergan IM, no exceptions! It's great, and helps us out so much because next time they come in they actually have a vein we can use.

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I have seen phenergan ordered to be given with narcotics to potentiate the effect of the narc to avoid increasing to a higher dose of the narc. Im sure there are patients who prefer the rush they get with it undiluted which frankly I am not concerned about. My concern is the damage phenergan can do on a vein... Have you ever seen a vesicant extravasate? It is not pretty and There have been many sentinel incidents where phenergan has caused serious tissue damage. I would push it via a central line but never undiluted through a peripheral

IV. Just because it is ordered that way doesn't mean you have to follow it if you deem it unsafe care... Patient safety first, not blindly following orders from the infallible physician is your priority. If the patient isn't happy with it, too bad so sad.

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Specializes in LTC.

I was recently in the hospital for six days with acute pancreatitis and had a lap chole. I had phenergan and dilaudid IV. Some nurses didn't dilute the phenergan and I ended up with chemical phlebitis at one site that took weeks to go away. Burned like a son of a gun. CYA, dilute the phenergan. Drug books and policy say to do so....

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Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

Don't EVER EVER push undiluted Phenergan via peripheral IV....EVER. :no:

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Specializes in Public Health, TB.

When that patient needs skin grafts or finger amputations and sues, you can bet that MD will not be testifying on your behalf. Nor will your hospital.

To paraphrase my mama, if the doctor told you to jump off a cliff, would you do it?

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Specializes in Med_Surg, Renal, intermediate care.
I have no problem giving him both drugs together; however, I will not give phenergan IVP undiluted. CYA

this is how I feel about it.

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I never give phenergan IVP. Ever.

IM or diluted in 50 ml NS and piggybacked in.

Some hospitals have policies that state phenergan can only be given IM.

So, even if I had a MDs order to give phenergan undiluted. I would refuse. I, personally, would like to keep my license and my money, and, if a lawsuit were to happen d/t this patient losing a limb from undiluted phenergan (and you know this kind of ******* would sue), it would be MY ass on the line (not the MD) for giving it.

I would question this doctor regarding this order. Then, if necessary, I would bring it to the attention of his superior. It's an irresponsible and dangerous order.

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Specializes in tele, oncology.

Phenergan IV has been a no-no in my hospital system for years. Check out pics of a phenergan extravasation and you'll see why. And unlike some other vessicants, once it's in the wrong spot you're screwed, there's nothing you can do to ameliorate the situation. We give it IM or PO, and that's it. Maybe you could show the pt a pic of what could happen and explain that you're just trying to keep his best interest at heart?

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Ok to clarify a few things....The pt didn't have a PIV he had a PICC line and yes the normal policy for administering Phenergan is to dilute with 50cc of NS and run it IVPB but as I stated in my original post the MD gave order to give it this way.. 1 so we wouldnt have to call him everyday to get his dosage changed. 2 so he could keep him as a patient as he was frequently in and out for various reasons..

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Give as per your hospital policy. You are employed by the hospital. If you violate policy and something happens, you will not have a leg to stand on in court.

The hospital will not back and the doc will not back you. Even if there is an order, the final responsibility rests with you.

MD convenience is not a valid reason.

Refer this to your supervisor and/or pharmacy.

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