Change in IV Phenergan Policy

Nurses Medications

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Have your hospitals recently changed their policy for IV Phenergan? Just this week I noticed that we now have to try 6.25mg first then 12.5mg, it has to be diluted in 20ml and given over 15 minutes. Now I know why I got in report from the ER that they gave a patient Zofran for nausea. They never use to give Zofran. I looked up some stuff on the internet and I guess Phenergan is a vesicant that can cause loss of limb if injected interarterial. What are the other reasons for the change? If this is true I can see why the policy change, but I am sure a vomiting patient will not like waiting 15 minutes for the Phenergan to be injected.

Specializes in Intensive Care - MICU/SICU/CVICU/CCU.

interesting thread... and some scary stuff! i've had phenergan GIVEN to me once undiluted post-op and it burned like battery acid going into my vein, but luckily that was the extent of the negative reaction.

when i administer it, i always dilute it in 10-20 ml of ns (depending on the dose- 12.5 or 25) and push v-e-r-y slowly through a running iv line. no adverse rxns so far. also, i work agency and none of the hospitals that i have worked at have changed their phenergan policy to date. (although i am noticing the lower doses being ordered much more frequently by physicians.)

Specializes in Cardiac, ED.

I don't even use it anymore.....risk of loosing a limb for using an antiemetic......talk about side effects of drugs.....I just tell the Doc to give me compazine instead....unless they want to stand next to a pt's bed for 15+ min....lol

I don't even use it anymore.....risk of loosing a limb for using an antiemetic......

When given properly and diluted correctly, there is virtually no risk of losing a limb.

Specializes in Cardiac, ED.
I took care of a patient who had phenergan given through an infiltrated IV in her hand. She didn't lose the hand, but required extensive reconstructive surgery. It had eaten through to the bone ...

When I was a patient (on my own unit), I requested that my phenergan be given p.o. An LPN I worked with on nights came in with a vial, got totally bent out of shape when I balked, and so I told her ok, but dilute it and push it VERY slow. The next thing I know, I feel a horrible pain from my wrist to shoulder and see her pull the 3cc syringe out of the port. She had rapidly straight pushed it into my IV undiluted. I swore a blue streak and asked her what the **** had she done... she said "well it dilutes in the IV tubing" and then left the room because she knew how angry I was...

I remember thinking I was going to die; my respirations were gasping, I couldn't speak. I truly have no idea how long this went on. It felt like forever. I remember our tech taking my BP and freaking because it was 70's systolic.

I ended up with a serious case of phlebitis in that arm, swelling to twice its size.

I tried to talk to her and tell her what her mistake was, but all I got was excuses of how busy she was, how she didn't have time to stand and slow push meds, etc. I ended up reporting her to the director. I was ok, but I had to let them know as she could seriously hurt another patient with her ignorance.

LPN and IVP, isn't that against the law????????????????

Specializes in Med/surg/tele/OR.

Our hospital changed the policy on phenergan also, it is only allowed as an IM injection now. I have not given phenergan very often since this. we usually give Zofran now. Never knew why until now

Our hospital has recently changed the phenergan policy. We dilute 12.5mg in 10cc and 25mg in 20cc and inject over 15 or 20 min. We usually use syringe pumps for this. If the pt has a compatible IV fluid running, I use a port away from the site. Some people think the time frame is unrealistic but why take the chance.

Specializes in CCRN, ATCN, ABLS.

We piggypack ours for 15 min minimum.

LPN and IVP, isn't that against the law????????????????

No. Our LPNs are allowed to administer IVP meds.

Specializes in med/surg, TELE,CM, clinica[ documentation.

We gave it mixed in a 50cc bag of NSS and infused as a piggyback or alone over 15 minutes :)

If your hospital has gotten rid of promethazine, you might consider asking the clinicians about using benadryl instead. Beanadryl is an antihistamine just like phenergan is and has antiemetic properties. Others with antiemetic properties include alprazolam, lorazepam, diazepam, hydroxyzine.

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