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
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.
Agreed.
But she was asking if there is still a chance for complications with this particular patient.
At my hospital, the standard order is 12.5 mg phenergan IVP diluted in 10 mL of NS if the patient has an IV running, or diluted in 50 mL of NS ran over 30 minutes if they are not receiving IVF.
IN the ER I work there are no protocols in place re: phenergan, but I was trained to always put it in a 50 mL bag and run it slowly over at least 15 minutes; better, if the pt. is getting a fluid bolus, to insert it into the bolus and let it run over 30 to 45 minutes, depending on how fast the bolus goes in. Also, because of how sleepy it can make pt's, make sure they are on the monitor and you are monitoring pulse ox--I've had a couple pt's dip to 89% who had to be put on supplemental oxygen until they woke up.
Specializes in orthopedic/trauma, Informatics, diabetes.
Ours is mixed in the pharmacy and given as a bolus mixed in 50mL saline over 15 minutes. That is usually third line. 1st is IV Zofran, PO phenergan and then IV if needed. We have used reglan, but it seems there is a shortage from the manufacturer. Some pts compazine works well
I don't see it used too much anymore. But when I do,I dilute it in a 50ns bag and run it overat least 15-30 mins.Never had any problems with that.
Dumb question though. If its so bad for the tissues if it extravasates ( sp?) , why is it ok to give IM? doesnt that make for a very sore muscle?Just curious.
Dumb question though. If its so bad for the tissues if it extravasates ( sp?) , why is it ok to give IM? doesnt that make for a very sore muscle?Just curious.
I've never given it or received it myself, but I've heard that it's a seriously painful injection. A friend of mine mentioned that it felt like her backside was on fire for AGES after it.
Specializes in Infusion Nursing, Home Health Infusion.
In my experience, if there's going to be a problem, you'll see it almost immediately.
;Nope this is not true! if you have an extravasation, which is the inadvertent administration of a vesicant or irritating drug or solution into tissue, the damage may not manifest until days or even a few weeks after the event. Phenergan would qualify as an extravasation if it leaked into the tissue or was given into tissue. It also can cause damage if given accidentally into an artery. Hopefully, you would notice that it extravasated and can take action and even then the true extent of the damage may not be known or be evident.
As far as giving it via piggyback. I would rather push it and have direct observation of the site at all times. I see too many nurses hang a vesicant via piggyback and come back 30 mins to one hour later and the whole thing has extravasated. Some believe that diluting medications always makes it safer and that is not true either. Some medications are inherently irritating and no matter how much you dilute it, the medication it will not change its potential to irritate the vein which may lead to infiltration and extravasation and potential to cause tissue damage or death.
it does not sound you had any of these problems though and I am just providing information.
Dumb question though. If its so bad for the tissues if it extravasates ( sp?) , why is it ok to give IM? doesnt that make for a very sore muscle?Just curious.
My guess is that muscles have bigger blood vessels, so it gets absorbed relatively quickly. SC injection or extravasation leaves a big pool of nasty just hanging around because absoroption rate is slower, so it has more time to do some damage. I have thought about this question before, but haven't asked one of our doctors yet :)
I've never seen Phenergan being used IV, and I've only been ordered to administer IM injections of Phenergan to patients with a PCEA who experience itching, when Zofran offers no relief.
In my current ER, we have no rules but standard is to dilute it in 10 ml and give it in a running line. Previous ER, floor could give phenergan but ER couldn't give it IVP. Other ER I work in, phenergan is IVP diluted and max 25 mg.
I know one doctor recently ordered it IVPB. I questioned it because to get it in IVPB form, I had to get it from pharmacy. If he wanted it IVP, I could do it in the ER. He just wanted to make sure it was diluted.
Also, I was always taught phenergan and toradol must go into a large muscle. The other day I saw someone use toradol on the deltoid which was weird. I have had someone try to argue to use the deltoid for phenergan because it is absorbed quicker. Personally? I wouldn't risk it. They get those drugs in large, well developed muscles.
Where I worked, from 1995 to 2005, we (I) gave 25 mg phenergan IVP all the time. I don't even remember for sure if we even diluted it, but honestly I don't think we did?
Anyway we never had one incident thank goodness. Yes I'm glad EBP has changed when and how phenergan is given. I know it is harmful, but just saying!!!!
A thread about all the unsafe dangerous practices that were part of a normal nurses day 20 to 30 years ago has probably been done, but would be fun to start a new one.
SmilingBluEyes
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