Phenergan dilution

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Question about administration:

I know IV Phenergan has to be diluted before being given through a large bore IV. Is there a difference in diluting it in 10-15 mls via a syringe pump/piggyback or injecting it into a 1L bag of NS? - besides the obvious that the 1L will take longer to infuse? Will the dose still be effective? There's nothing wrong in injecting it into the 1L correct? There will still be relief? Thanks in advance!

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Specializes in Trauma Surgical ICU.

Are you a RN? Doing that in a 1000cc bag, why? 50cc bag or even a 100cc bag I could see but not 1000. Depends on hospital policy, many have moved away from IVP because of the dangers. Look it up if you haven't already. Thankfully we use more zofran

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Yes I'm an RN. I just used a 1L NS bag because that is the most common IV infusion we give. We don't carry NS 50ml or 100ml bags. So if a patient had a L of NS infusing or something, would injecting phenergan 12.5-25mg into the bag still have the desired effect? I just want some opinions on if it is acceptable to do it this way. That even though it will take longer to get the full dose that the effect will be the same.

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Specializes in Emergency Department.
Yes I'm an RN. I just used a 1L NS bag because that is the most common IV infusion we give. We don't carry NS 50ml or 100ml bags. So if a patient had a L of NS infusing or something, would injecting phenergan 12.5-25mg into the bag still have the desired effect? I just want some opinions on if it is acceptable to do it this way. That even though it will take longer to get the full dose that the effect will be the same.

Given that your ED apparently doesn't have small IV bags (mine has 50, 100, 250, 500, and 1,000 mL bags of saline) I would suggest finding the smallest bag your ED has on hand and put the Phenergan into that and run it in as a piggyback. The med should have essentially the same desired effect once the full amount has been infused as a smaller volume but same time-frame. What's interesting about this particular drug is that while it's recommended to give it over 10-15 min (diluted in NS or D5W) you can give it at max rate of 25 mg/min. Just expect that you may have a transient decrease in BP if you go that fast. That would mean IVP so make sure you're giving it through a running line if you do give it IVP.

Personally I wouldn't put it in 1000 mL bag that's already infusing because if you end up having to hang other meds as a piggyback onto that med, there are quite a few meds that aren't Y-site compatible and that could cause problems. I'd run it (ideally) as a small volume piggyback and once that's done, the primary (and unmedicated) line flushes the rest down the tubing so that you can then later do another med using that same line. Small volume piggybacks also help keep the total volume of fluid under better control...

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First, think about the reason that it is recommended to dilute Phenergan for IV administration.

It is because this medication is a vesicant.

This means that this medication can cause tissue damage and necrosis.

If you dilute it in a 1L bag of NS, are you going to sit there and monitor the entire infusion? Or are you more likely going to start the infusion and then leave the room to go tend to other tasks?

More important than the amount of diluent you use is that you monitor the infusion as it is going in, and be prepared to stop it if the patient complains of any adverse symptoms.

Given this, this is why diluting promethazine 25mg/mL in 10mL NS and pushing it into a running IV line over at least one minute is the preferred method.

Either that, or stop giving it IV and only give it IM- which is what most EDs are doing these days.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
We don't carry NS 50ml or 100ml bags.

Really? What about mixing abx — does the pharmacy always do that for you? That's probably where you can get smaller bags of NS, by the way — pharmacy. Assuming you're not in a freestanding ED not attached to a hospital with a pharmacy.

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Specializes in Trauma Surgical ICU.
Yes I'm an RN. I just used a 1L NS bag because that is the most common IV infusion we give. We don't carry NS 50ml or 100ml bags. So if a patient had a L of NS infusing or something, would injecting phenergan 12.5-25mg into the bag still have the desired effect? I just want some opinions on if it is acceptable to do it this way. That even though it will take longer to get the full dose that the effect will be the same.

I don't think it's safe to do it that way. The pt would not get relief as fast as they should nor do you have the time to watch the whole NS L go in to make sure the site is good etc. Also you run the risk of mixing it with other meds, sending the pt to the floor with it still infusing etc. Not good practice.

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Perfectly safe to do that, but would only make practical sense if you were running in the liter as a bolus, as with a hyperemetic mom or some heat exhaustion dehydration type patient, etc. The drug would have the same effect of an IV push or IM shot and you wouldn't have to worry about blood vessel damage or pain either because of the dilute concentration. Even if the line infiltrated, you'd just start another one and keep going with the same set up.

Concerns about compatibility are legitimate, but if the liter were going to run right in, you could add other meds immediately afterward and not delay things.

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Specializes in Registered Nurse.

A usual dose of Phenergan would not be given in 1L. How would you even know how fast to run it?...and for many people that may be too much fluid. The Docs I work with would have a field day if you asked them to put it in a liter of fluid OR look at you dumbfounded, depending on the Doc. Not trying to be condescending- just was envisioning asking our Docs that! lol If you think it is not compatible, look it up, ask a pharmacist...or flush inbetween it and the other meds.

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Specializes in ER/Trauma.

I generally don't add anything to 1 litre bags - if any drug needs that kind of volume dilution, pharmacy needs to do it because I don't have the expertise.

We don't stock IV/IM Phenergan in our Pyxis anymore (haven't had stock in years. We DO stock Phenergan PO). All our IV/IM Phenergan comes from Pharmacy - usually in 50 cc bags.

cheers,

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Specializes in ER.
All our IV/IM Phenergan comes from Pharmacy - usually in 50 cc bags.

cheers,

Seems like an awful lot to waste if you're giving it IM. Or is it coming from pharmacy at 25mg in 50ml? I'd hate to stick a patient that many times.

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