Worried about phenergan IV push

[Jaellys]

I always knew that phenergan should be given cautiously due to the possible complications when giving iv push. I gave a young 40 something year old patient 25mg phenergan diluted in 10 ml normal saline in his peripheral iv in his forearm. He also had a NS running at 125cc/hr. I gave it over 2 minutes.

He denied any pain, and his iv site looked great and no burning or pain was ever experienced throughout the rest of the shift.

Ive been told that people can lose limbs if given peripheral iv. That was how it was ordered and nurses before me were giving it that way.

If if he didn't complain of any pain in his arm/iv site all shift, is it ok? Or could there still be a chance for complication? I pushed other meds in that line later in the shift with no complaints. I'm just really worried about it

[Penelope_Pitstop, BSN, RN]

Phenergen can do some nasty stuff if it's leaked into the tissues. A simple Google images search will show you that. So you are very right to be cautious about giving it.

When I was a new grad in 2006, I worked on a surgical floor and gave IVP Phenergen like water. Zofran had just come out and was really expensive. Anzemet existed at the time as well but was really only used in the OR.

The rule was that it had to be diluted in 10 mL and pushed slowly into a Y-site with fluids infusing. You did all of those things! Keep up the good practice.

Now, fast forward almost ten years later and the same healthcare system I just mentioned stopped allowing Phenergen IVP. IM is okay. So your hospital may head that way as well.

[BecomingNursey]

Our hospital policy on Phenergan administration has changed within the past 2 years also. Our policy is 6.25 mg of Phenegan is the maximum dosage allowed to be given IV. If the physician wishes to give more than that it must be IM.

[Lunah, MSN, RN]

One ER where I worked will not allow Phenergan IVP in a dose higher than 12.5mg. Elsewhere, no restrictions but I am uber-cautious — very diluted and slowly with infusing fluids.

[VANurse2010]

The way you did it is fine. You can always try using a bigger syringe and diluting it with more saline. You could also mix it in like a 50cc IVPB and run it as a piggyback.

IVP Phenergan is no longer allowed at my hospital - which is one reason I'd never have surgery there!

[Jaellys]

Thanks for the replies guys. I still want to know, though. When do symptoms usually arise after giving phenergan iv push if they do? He was fine all shift (5 hours after). No burning or anything. In the clear? The reason I ask is because I was told IVP is very dangerous

[VANurse2010]

In my experience, if there's going to be a problem, you'll see it almost immediately.

[TheCommuter, BSN, RN]

If you have time to burn, feel free to read my informational piece on Phenergan (Promethazine). Click on the link below to read it.

https://allnurses.com/nursing-patient-medications/protect-your-patients-759687.html

[SmilingBluEyes]

You should be worried. 3 of the 4 last hospitals I worked at it forbid IV push Phenergan. It's a severe vesicant and can do a lot of damage. We always gave it in at least 500ml of saline IV. When I had my last baby, I was given Phenergan IVP and it was done slowly but still infiltrated and cause SEVERE pain in my arm. It was awful. I would not want to inflict that on anyone else.

[AnnieOaklyRN, BSN, RN, EMT-P]

Thanks for the replies guys. I still want to know, though. When do symptoms usually arise after giving phenergan iv push if they do? He was fine all shift (5 hours after). No burning or anything. In the clear? The reason I ask is because I was told IVP is very dangerous

People loose limbs when it EXTRAVATES (sp) though an infiltrated IV, not when it is pushed through a patent line! If you think your IV is infiltrated do not push it, if you push it and then think it infiltrated then leave the IV catheter in place and call the pharmacy as you may be able to put another medication in to neutralize it.

The burning, if they have it, will be as you are pushing it.

Always examine the extremity with an IV line in it for edema or erythemia, and flush the line, even if there is NS or other maintenance fluid running to be sure the IV is still in the vein. If there is any questions as to whether or not it is or isn't, or if the patient complains of pain while pushing a NS flush do not push any medication through it.

Annie

[NanaPoo]

You should be worried. 3 of the 4 last hospitals I worked at it forbid IV push Phenergan. It's a severe vesicant and can do a lot of damage. We always gave it in at least 500ml of saline IV. When I had my last baby, I was given Phenergan IVP and it was done slowly but still infiltrated and cause SEVERE pain in my arm. It was awful. I would not want to inflict that on anyone else.

5 hours after the IVP the patient was completely fine, never experienced any symptoms or pain, she pushed the Phenergan with 10ml of NS and while IVF were running at 125ml/hr but she should still be worried?

I completely disagree with you.

She has no reason to worry and the patient is fine.

[SmilingBluEyes]

5 hours after the IVP the patient was completely fine, never experienced any symptoms or pain, she pushed the Phenergan with 10ml of NS and while IVF were running at 125ml/hr but she should still be worried?

I completely disagree with you.

She has no reason to worry and the patient is fine.

Maybe not this time, you are right about that. But in the future---strong reasons why not to do this. Ph of 4.5 roughly, dangerous to surrounding tissues if it infiltrates, including at the extreme, amputations.

There are many places that no longer allow Phenergan straight IVP. Good reasons why.