Question about Phenergan and tachycardia SE...

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Specializes in ER.

The other night, I had a patient with gastritis, puking their heart out. Doc orders 25 mg Phenergan IV and 0.5 Dilaudid IV. We usually use Zofran, but the patient had a long list of allergies that included Zofran and Compazine. Also ordered was a liter bolus of NS, due to the dehydration with a HR of around 100.

So, being the smart little new nurse I am, I put the Phen in a 50 ml bag of saline, and ran it in through the main NS line (wasn't bolusing yet, just a fast KVO). I ran the Phen in over about 5 minutes. Because of all the other allergies, I confirmed before I gave it that the patient had had it before.

So, as it's finishing up, I'm in the room charting a few things, getting ready to give the Dilaudid (after the Phen...I was tired of the puking as I'm sure they were too!). The patient asks me if it's normal to feel their heart racing with this med. I figured that it was a little anxiety (very anxious patient), and turned around to see the pulse ox reading 190! And yeah, it really was that. Dang it.

Anyway, the Phen was already infused. I turned up the liter to start running in. BP was still WNL, pt denied anything other than "racing", didn't get diaphoretic. We all kind of stood around and watched, and it slowed down to about 140 after 4-5 minutes. It took about 30 minutes to get back to around 100. (However during that first 5 minutes, when questioned further pt restated that they had had it before...but that it had made their heart "race" then too. Thanks. The first time I asked would have been the optimal time to share that tidbit.)

So, this was my wordy way of asking if anyone has ever seen this before, or what I may have done differently (besides grilling the patient on any other fun experiences they had ever had with meds that they failed to mention). I called the pharmacy to ask if I needed to report the reaction, and they said no, since tachycardia was already in the literature ("Yeah, but this more than just your average tachycardia!")

I do have to say though, at least it didn't burn them. :D

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Specializes in Cardiac, ER.

Phenergan isn't as bad as Compazine,.but it does do this alot. We try to start with 12.5mg because of that (I remember giving 50mg!) People also report increased anxiety,.the need to get up and move and I often see tremors,...BUT,.it does stop the puking! :) I personally like to mix 12.5mg in at least 100ml and run it over 30 min. I also try to warn the pt that these sx are "normal" reactions and usually don't last long. A small dose of Benadryl sometimes helps too! BTW our cardiologists do not allow their pts to take phenergan or benadryl!

Try it really slow next time and warn the pt what to expect,.might go a bit smoother for you and the pt!

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Specializes in cardiac ICU.

Just btw, Phenergan is known for lengthening the QT segment--even with moderate tachycardia I would probably check their QTc to be safe.:nurse:

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Specializes in ER.
Just btw, Phenergan is known for lengthening the QT segment--even with moderate tachycardia I would probably check their QTc to be safe.:nurse:

Initially, I didn't have them on a monitor because, well...it was gastritis. Plus, they were getting up to go to the BR every few minutes. When they tached out, I put them on the monitor quick like a bunny, and did a 12 lead. Did a repeat 12 lead an hour later when they had settled down. It was back to 90ish at that point, and the QT was normal. However they has mild sinus arrythmia. Now, I don't know if that developed because of the reaction or if it was normal for them.

You can bet your bippy that next time I give it, it's gonna be so slow that I may as well just hold the vial next to them and wish it in. :D I kid. But dang it, I've probably given gallons of Phen over the years on the ambulance and never had a problem...and that was back in the days when we used to practically mainline it to them through a lock! But the first time I give it as an RN and BAM! :lol2:

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Specializes in Psych, ER, Telemetry, Float.

Never heard of tachy episode from Phen. I have heard MD's getting their knickers in a twist when I pt is given Phen is a small iv bag if they are overly concerned about fluid overload. OBVIOUSLY this wasn't the case as they were bolusing w/ a liter anyways - just be careful when using that trick (I use it all the time myself) and know the MD and situation before you do that.

Good Luck!

-Az.

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Specializes in Trauma/ED.
I personally like to mix 12.5mg in at least 100ml and run it over 30 min.

Wow...I can't imagine taking the time for this...I work in a busy ED where 30 min is a long time and plenty of time to see if the antiemetic worked or if we need to try something else.

I do give it very slow high in the line of w/o fluids and have yet to have a problem. For me the difference between 5 min and 30 min is HUGE.

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Specializes in CNA, Surgical, Pediatrics, SDS, ER.

Wow...I can't imagine taking the time for this...I work in a busy ED where 30 min is a long time and plenty of time to see if the antiemetic worked or if we need to try something else.

Same here. I just gave 25mg last noc doc ordered only SL no other fluids (specifically said no other fluids), so I pushed it really slow. I personally don't like to give 25mg because 12.5 usually does trick. This woman got immediate relief she settled w/in minuites of giving it. She did not have any c/o after getting it & no reaction to it. Thus far I have not had any problems w/ giving it (hope I didn't just jinx myself!) but I've heard other nurses who have had issues w/ it.

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Specializes in Emergency & Trauma/Adult ICU.

I agree with the above posters ... I expect my patients will have relief within 15-20 minutes of antiemetic administration, or I'll be looking to give something else. repeated administration over 30 minutes might work well in an inpatient setting.

Phenergan was great in certain circumstances ... unfortunately it's been removed from our formulary.

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Specializes in ED-CEN/PACU/Flight.

Wow...

We're only allowed to give Phenergan through central lines, rectally, or IM. We are not allowed to give IVP anymore.

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We give phenergan in PIVs all the time. As long as you dilute it appropriately and push it slowly (in a patent PIV) you shouldn't be having a problem. I typically mix 12.5mg in 10-15ml of NS>

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Specializes in ER/PDN.

I haven't heard of the tachycardia issue BUT--

our policy (as of last year sometime) is that Phenergan is mixed in at least 20 ml of NS and given over 10-15 min AND never in a hand vein.

I learned this lesson the hard way as a patient. My nurse didn't follow the policy and gave the drug diluted in 2 ml NS in the closest port in my hand and my arm was sore for 2 weeks after administration and my veins in my hand and wrist are hard with scar tissue now. Every once in a while I still have pain at the site. So I follow the policy to the T now because I don't want anyone to have to go through that or the gangrene that it can cause.

Just my 2 cents.:specs:

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

I like to give it as an IV-PB also, but If you cant do this I also like to dilute it in 20 ML, push it slow from high in the line and I like to like titrate it I give half first 12.5 then another 12.5 later if needed.

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