Worried about phenergan IV push

VANurse2010 · Feb 5, 2016

;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.

this nurse would have noticed after 5 hours if the PIV had become dislodged - and then could have assessed for problems. There is nothing dangerous about giving promethazine through a working IV.

~PedsRN~, BSN, RN · Feb 5, 2016

Interesting how many places no longer allow this IVP. I had no idea! I know it's a nasty nasty drug, and care must be taken when administering... We dilute and IVP it on our floors in the pediatric population - but only as a last resort when zofran doesn't work.

I like to just ask for it PO. Easier for all involved.

VANurse2010 · Feb 5, 2016

Interesting how many places no longer allow this IVP. I had no idea! I know it's a nasty nasty drug, and care must be taken when administering... We dilute and IVP it on our floors in the pediatric population - but only as a last resort when zofran doesn't work.
I like to just ask for it PO. Easier for all involved.

Giving something po to someone who's vomiting every 5 minutes isn't exactly a solid plan.

Wrench Party · Feb 5, 2016

I have given aplenty 12.5 mg Phenergan IV diluted in 10 ml NS, with NS flush before and after, pushed slowly, with no other fluids running. No one has complained of any burning and I've never seen it inflitrate. Did I miss something?

Guest849204 · Feb 5, 2016

First thing to do is look up your hospitals IV policy for nurses, they will usually include important information specific to drugs like phenergen that have specific things to be cautious of.

And of course, report any signs of a negative reaction.

Nalon1 RN/EMT-P, BSN, RN · Feb 6, 2016

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.

When I was on the ambulance (1996-2008) we gave it all the time that way. No dilution. It was just the way it was done. No idea if I ever had any long term issues with the patients.

In our ER, it depends on how the MD orders it. Sometimes it is just 12.5 or even 25 IVP, which I dilute in a 10 cc syringe on NS and give slowly then flush with another 10 CC (of course always making sure I have a patent line). Sometimes it is ordered IVPB with 50cc NS over 15 minutes.

I have never seen it given IM, and as others have said, seem odd since it burns even in a patent IV, I know I would not like to have it IM.

TheCommuter, BSN, RN · Feb 6, 2016

Phenergan is only given IM where I work.

Phenergan is also given PO and PR (rectal) at my PRN place of employment. The rectal route actually delivers effective antiemetic properties that are comparable to IV administration. It's too bad that more patients are unwilling to receive a suppository.

megacheesehead · Feb 6, 2016

If Phenergan is a vesicant and will damage the tissue if it infiltrates, how can it be given IM? Isn't this like going from the frying pan into the fire?

iluvivt, BSN, RN · Feb 6, 2016

If Phenergan is a vesicant and will damage the tissue if it infiltrates, how can it be given IM? Isn't this like going from the frying pan into the fire?

Yes, it can be given IM with Z track being optimal. It is not the same as an extravasation in subcutaneous tissue or deposting it inadvertently near nerves or potentially causing a compartment syndrome. The muscle is very vascular and you are giving it in a controlled fashion and with a small volume that can be be easily absorbed.

Also, it would be an extravasation if it inadvertently was admnistewred into tissue

iluvivt, BSN, RN · Feb 6, 2016

this nurse would have noticed after 5 hours if the PIV had become dislodged - and then could have assessed for problems. There is nothing dangerous about giving promethazine through a working IV.

check this out.. I never said it is dangerous to give it IV push or in mini bag if the assessment is done correctly. I was correcting misinformation provided. Phenergan IV however, must be given carefully and with certain guidelines followed!

According to the package insert, Proper IV administration of this product is well tolerated, but use of this route is not without some hazards.â€ To reduce the risk of these hazards, manufacturer labeling recommends to: give the drug in concentrations no greater than 25 mg/mL; administer the drug at a rate no greater than 25 mg/minute; inject the drug through the tubing of an infusion set that is running and known to be functioning satisfactorily; and to stop the injection immediately if the patient reports burning to evaluate possible arterial placement or perivascular extravasation. Nonetheless, ISMP believes these long-standing hazards require further action on the part of healthcare providers, FDA, and promethazine manufacturers. In the 1970s, after numerous reports of infiltration and inadvertent intra-arterial injection of hydroxyzine, FDA asked the manufacturer to revise the label and remove IV as an approved route. Today the drug is only indicated for IM or oral administration. Similarly, FDA should carefully investigate adverse events with this drug to determine if labeling changes are warranted, including removal of approval for IV administration.

Prevention is the best strategy to avoid extrvasation!

ActualNurse · Feb 7, 2016

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

I haven't seen Phenergan used in this century. Is it making a comeback?

righteousjenn · Feb 7, 2016

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!

Not without an order you can't.