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've given phenergan IVP many times in the past, and was lucky to never have a complication. I was more worried about microscopic glass flakes getting past the filter needle when drawing it up. I was very nervous about the glass ampule necks that had to be snapped off (I knew an RN whom ended up with tiny glass specks in her eye for 2 days without realizing it). Even switching out needles prior to administration didn't assure me it was clear.
I wouldn't piggyback it, I'd y-site it below the pump. When you piggyback, the primary fluid stops, so you do not get the added benefit of further dilution by the primary fluids.
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!
In my experience as an RN we push Demerol and Phenergan a lot for pain. If the site is good and you push it slowly as you did it is ok. Diluting with saline is good. I heard some other nurses say their hospitals are switching to Zofran before pain med. This takes care of potential nausea, has less sedating effects, and is easier on the veins. You did fine.
I suppose my facility is still in the dark ages, because we give phenergan IVP all of the time. We do have a policy for administration- never in the hand/wrist, must be diluted in 10cc ns followed by 20 flush, pushed slowly (2 minutes) in a patent well functioning IV. Dose max is 25mg, 6.25-12.5 most commonly prescribed. It's almost always a secondary line of tx for N/V when zofran is ineffective.
I have never seen an injection extravasate/infiltrate on my unit, though I have heard of the terrible outcomes if it does.
At least in my experiences, IVP Phenerghan is a last resort after Zofran and Reglan.(I don't know why, other than availability, that Compazine is not used much.) While there are folks for whom the IVP Dilaudid/Phenergan cocktail does wonders for their pain, it is also a favorite for the drug seeking population. Apparently those two drugs potentiate each other and create something of a wicked high. Since I find it very inappropriate to be in an ER and make those kind of judgments (oh your pain isn't real so I'm gonna let you squirm), i am going to give what the doctor orders. Even if the patient is drug hunting, the ER (where it is conceivable that they just might be truthful) is neither the time nor the place to address those problems. Besides the vesicant risk, many facilities have gone to a no IVP phenerghan policy, just because of this.
As for the worry about IVP Pherghan, my personal rule of thumb is that if i am honestly not sure whether something is IVP-able (is that a word?) and I can't find a definite answer, dilution in 10ml of saline and slow push in a y site is generally a good option. unless the person is on fluid restriction, a little saline never hurt anyone. Besides as a poster above said, its pretty diluted in the maintenance fluids anyway. However I should think that a call to pharmacy for verification is always an excellent option too. Keep in mind though, this applies to the routine drugs (narcotics, anti-nausea, etc.) given in the ER. When you get to the less frequent things (Dilantin for example..Call Pharmacy!).
All that being said, from a patient perspective, I have been on the receiving end of pain control needs unfortunately rather frequently, my personal preference is Zofran first then the Dilaudid, diluted and nice and slooowwww. Otherwise, i promise I will hurl. I am not a fan of Phenerghan because of the loopy feeling that I get (admittedly I am something of a control freak). As a point, think about the generic name of Phenerghan---promethazine. It's chemically close to Thorazine (chlorpromazine), AKA old school antipsychotic. I've had Thorazine, IV drip (it's occasionally used for intractable hiccups. Try hiccuping with an NG in place, it's a hideous experience, I promise you.) It fixed the hiccups, but i don't remember the entire afternoon. Not a good experience.
Because phenergan can have some nasty results you always need to verify the IV is in good shape. Always always always dilute it and always alway push it over several minutes. I've never had a problem but have known nurses push it fast not "believing" it would actually do damage. They were wrong...
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.
I remember those days, and we didn't dilute. I also seem to remember a med that was popular at the time was mepergan, which was worse.
Axgrinder
256 Posts
I've given phenergan IVP many times in the past, and was lucky to never have a complication. I was more worried about microscopic glass flakes getting past the filter needle when drawing it up. I was very nervous about the glass ampule necks that had to be snapped off (I knew an RN whom ended up with tiny glass specks in her eye for 2 days without realizing it). Even switching out needles prior to administration didn't assure me it was clear.