Promethazine IV Question

Nurses Safety

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From personal experience as a patient, I know that when promethazine 25 mg/ml is administered undiluted into a peripheral IV site it burns and can cause chemical phlebitis. I am hoping to write my master's thesis on this subject and cannot locate any research data to support my anecdotal finding. If you know of any documentation to support my position, please e-mail it to me. I would also like to hear from anyone who has experienced a similar result from phenergan IVP.

Thanks,

Paul

Specializes in Psych, hospice, family practice.

My husband got IV Phenergan recently for N/V during a GI virus. REALLY messed his vein up. IV fluids were finished, so I guess it was given as an afterthought.

By late that evening, he started to experience a lot of localized reaction at the IV insertion site, and all the way up his arm, a path that was clear to me, was the path of the vein. I was ready to take him for immediate follow up of course, but men can me hard-headed sometimes(lol). The inflammatory process subsided after a couple of days, but he still has some distal tenderness.

Now that inapsine is on the "bad"list, our new policy allows phenergan IV only in a lg bore needle and never in a hand vein. Ww do tend to go for the hand a lot in the ED, and most pts have a line before the doc sees them, so we are allowed to mix in 50cc, and hang as a piggyback, even if in a hand. If we give inapsine, they go on a moniter, there is alos one other antiemetic that requires cardiac monitering, but cant seem to remember, I am definatly getting senile! Can anyone help my failing memory?

I've seen the problem with phlebitis when using Phenergan IV. I've also had (and been witness to) events when phenergan IV resulted in over-sedation of a patient... once when administering only 12.5 mg. In this case, we ended up giving narcan to reverse the morphine the patient had also received earlier. Of course, this had it's own ill effects, most notably irritability and severe pain. Even then, the patient was sedated for quite some time.

I find that patients who receive Zofran pre-op have far less incidence of nausea post-operatively. I know I try to avoid giving phenergan whenever possible.

Peace:)

Our policy was recently changed to having to dilute IV phenergan in 9 cc NS. And like before administering it over at least 1 minute. It amazes me that someone would give it undiluted :eek:

I once took care of a young construction worker who had been injected ARTERIALLY in the radial artery (inadvertently) with Phenergan. When I had him, he was on telemetry prior to having his hand amputated! The person who performed the injection was his physician, in his office!

On my floor, (peds) we only last week were ok'd to give phenergan and/or demerol IVP. Prior to that, we always had to give it IM (not too child friendly that way) Inapsine has been moved off the approved list also.

I am definitely going to remember these anecdotes and share them with my co-nurses.

That is just another reason this board is so GREAT!

Specializes in Med-Surg Nursing.
Originally posted by misti_z

Any drug book tells you to dilute in at least 5cc NS and give slow IVP like Kathy stated. Recently had a pt who had to have a vein stripped b/c of receiving phenergan IV undiluted and to quickly. :o

Hmm......I have given IV phenergan lots of times and have never diluted it. I have looked in several drug books--Nursing 2002 drug handbook and Mosby's 2001 Intravenous Medications handbook and neither one of those texts mention anything about mandatory dilution of the drug. Last hospital I worked at had a policy that stated that IV phenergan could only be given with a running IV. Current hospital I work at has no such policy. They don't even have a Pharmacy IV drug guide--we use the Mosby's 2002 Intavenous meds book.

I always push it slow and follow with a 5cc NS flush.

Like Kaknurse, we have no dilution policy at my hospital either, but since this thread first started I have been diluting it prior to giving it IV and leaving notes in the med kardex for others to do the same. Have had no complaints from pts since starting to do it this way, also copied the comments and took them in for the other nurses to read to enlighten them.:)

Specializes in ED staff.

There is no policy in my hospital either. Like many of you I learned from personal experience just how badly it can hurt. I had an ulcer last year and was in the hospital for 2 days...had 5 IV's during that time. I've made it my personal crusade to educate other RN's in the ED to dilute Phenergan in at least 10 cc of NS even if you have a running line. We give a lot of Demerol/Phenergan IV, I always give it separately. I give the phenergan first, wait a few minutes and then give the demerol. I've found that I get much less vomiting in response to the demerol that way.

The first time I pushed phenergan, it was undiluted and as I watched, the web of all the vessels proximal to the site turned red like I was putting red dye in. OUCH!!! Sorry!

Dilute with 10cc saline....that stuff burns up veins like wildfire....and according to the patients , feels the same way......

Well, I'm not sure what to think now. I gave my first iv push phenergan just this afternoon. It was given in a central line. The order called for 12.5-25 mg q 6 hours. My drug book indicated to dilute 25-50 mg with 9 cc of saline and to give 25 mg or less/2 mins. The pharmacy instructions on my MAR indicated to dilute the 25 mg and give over 2 mins. Another nurse stated they usually diluted it. I gave the 12.5 mg and with my drug book and the pharmacy instructions as reference I did not dilute this dose and gave over 2 minutes. My pt. had no problems indicated or c/o during or after receiving this.......but, did I really screw this up or what??

Lisa

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