Promethazine IV Question

Nurses Safety

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healingtouchRN

541 Posts

Specializes in Cardiac/Vascular & Healing Touch.

must dilute per policy @ my place. I often find the tell-tell signs of someone not diluting when I go out to the med-surg floor (when super says "can you start another IV on so & so?") I ask the patient if the drug was in a big syringe or little syringe? You know the answer. It is very caustic to the vein!!!!!! Must read the nurse drug book on giving the meds. OUCH!

webbiedebbie

630 Posts

Specializes in OB, Telephone Triage, Chart Review/Code.

I had to give Phenergan 12.5 ml IV just the other night. I had read the original post and diluted it in 9 cc. When I came back the next night, the pt's IV had to be restarted on the day shift d/t phlebitis. You can bet, I gave the next one diluted in 20 ml. Haven't heard yet if the pt had any problem with that one.

have you searched under chemical phlebitis, extravasation? Get the pharmD to get info from the drug rep-they can ask for recent studies (you MIGHT get it yourself) and the studies (which are biased) will have references. Have you had incident of psychotic episode following infusion of this drug? Happens with peds sometimes.

Zoey65

9 Posts

Oh my goodness, I am back in nursing after being out for 10years. I only have experience in a nursing home where I gave no meds or anything else. I am relying on my institution and preceptors to guide me and have been giving IV med w/o diluting most of them. I try to read what they are for but haven't seen where to dilute. I need advise on where to find this info.

Specializes in Flight, ER, Transport, ICU/Critical Care.

As an answer to the original post, there are several items to keep in mind. The reason that the Phenergan has such bad effects is all pH related. It is quite acidic (I don't remember - but I think it is around a 4 or so) Do dilution with 0.9% NS doesn't change the pH. So ....

As a practical matter, it could be diluted and then pH reduced to neutral with small addition of NaHCO3. I cannot find a reference detailing a issue with that - but, I do not know as a practical matter. I have thought about it, but my current "position" keeps me from any policy input. Would need some type of standing order or such.

As a practice issue, I ALWAYS dilute everything that goes IVP except Code drugs and adenosine. I generally dilute to a level necessary for the access device the patient is using. Before giving any med in an lock access device, I always aspirate for blood return and then flush the port to be used with a 10-20 ml saline to assure that the site is patent.

There may be differences or no mention as to specific policy, but I think there are some practical "best practices" that benefit patients.

Specializes in Med/Surg, Home Health.

I was in the hospital a month ago and I experienced this first-hand. While this nurse was pushing the phenergan into my IV, I asked her if she diluted it. She said "well, no, I guess I could have". It burnt like heck and I still have a huge lump and my vein is now hard. It literally feels like a big wire in my arm. Good luck with your paper.

20RN06

7 Posts

Are extrapyramidal effects from Phenergan use usually temporary, or permanent? I gave 25mg per MD order to a 77yo F patient, and have been traumatized since w/her reaction to it. This happened 3 days ago and being a new nurse, I wonder if I can handle this career anymore... =S

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

The FDA receiently released a warning with regards to phenergan stating it should not be given in a pheripheral iv in the hand and that it should be diluted before administration as it has caused a couple patients the loss of fingers and severe infections secondary to its caustic nature.

20RN: have to be careful with phenergan especially in the elderly as it has antihistamine properties and can make a person really sleepy.

Swtooth

Pt is receiving phenergan, usually for acute nausea, with associated vomiting...Also common w/ the phenergan order, is a litre bolus...

Forget the piggyback and pushing over 5 minutes...

Put the phenergan in the litre bag...It will infuse over 15-60 minutes (depending on the IV size)

I've been doing this for 10+ years, w/ NO side effects...

jannrn

104 Posts

Specializes in Med/Surg, Perinatal, Float.

We are not allowed to give phenergan IV where I work, but PO or PR. Works great though! At another facility I gave a long-term antepartum pt. (81 days) IV Phenergan every 4 hours durning her stay through a central line. she said she could always taste it.

imenid37

1,804 Posts

Action needed to prevent serious tissue injury with IV promethazine. This link is the Institte for Safe medical practices and is referenced by most of the other articles I found on this subject.

CarVsTree

1,078 Posts

Specializes in Trauma ICU, MICU/SICU.

Phenergan IV will no longer be on my hospital's formulary beginning 1/1/07. Darn shame! Works really well on my concussed patients. I do however agree that the risks outweigh the benefits though. Buy oh my, I do hate vomit! :trout: :barf02: :trout:

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