wrong route phenergan?

[cybernurse614]

I work at a OB/GYN clinic. I am a new RN and was asked to give phenergan IV push into already started IV. I asked the doctor if I should give the medication IM rather than IV after being warned of possible complications. The doctor wanted IV and I was advised to go slow. I diluted 25mg in 10ml 0.9% NS. The tubing used in our office requires needles for injecting into the port which I was unfamiliar with. I used a saline lock and administered over 10 min. Then restarted the IV to finish off last 500ml of LR. Patient had no complaints of pain, redness or tenderness. Now I am reading about all the complications and freaking out! Any advice would be helpful. Am I overstressing out?

[ERNURSE158]

Can't give Phenergan IV???? I can't imagine life in the ER without IV phenergan. I mean...what good would PO be when the pt is projectile vomiting? I realize there are alternatives like Zofran, Reglan and Compazine...but nothing beats a good dose of sleepytime phenergan. Its true that it can be a bad thing, but if you assess the IV before you give it...and make sure its in the vein, You should be fine, I've even seen some nurses mix 25mg of Phenergan in 50ml IV bag of NS and let it run in.....I mix mine in 10cc NS like you did and I rarely have issues, some patient complain of a burning sensation, but if they do I typically add more saline or turn up the line so its diluted more.

[GrumpyRN63, ADN, RN]

LOVE Phenergan, been giving it IV for 20 yrs, back in the day pts were ordered 25mg IV q4hr ATC X 48 hrs post op. Those were the days, never, ever had IV issues, still give it, usually 12.5 IV in 10cc on secondary, love how it snows 'em, great drug when all else fails

[10MG-IV]

LOVE Phenergan, been giving it IV for 20 yrs, back in the day pts were ordered 25mg IV q4hr ATC X 48 hrs post op. Those were the days, never, ever had IV issues, still give it, usually 12.5 IV in 10cc on secondary, love how it snows 'em, great drug when all else

fails

I will be the "Phenergan Nurse" what a specialty... although, for those retching Eggheads that change admin / delivery rules on drugs we love, I would have to give it rectally. Do you have to remove that foil for it to be effective????

[suni, BSN, RN]

I have seen reactions to Phenergan IV from venous irritation to an area that required debridment. I hate to push but always dilute it, push slowly and usually also apply a warm compress to the site prior to and after the push.

THis drug is nasty. I did try to dilute it in 50cc of NSS and hang it as a mini bag however this is not recommended because if it infilitrates you are not there to see it, I only did that once and stayed in the room with the patient the entire time.

[Tait, MSN, RN]

I got IV Phen once for a bout of viral gastroenteritis. I got a warm vein and then went totally loopy . I was talking to imaginary people and then falling asleep, but man it sure made me feel a lot better.

I mix in 10 and push nice and slow, assessing the patient for discomfort at all times. I have never had it perscribed for a patient much over the age of 55, but I can imagine it would blow the heck out of those 70+ veins.

I do prefer Zofran for my patients, gives them relief while letting them maintain thier consciousness. :)

[Kthale81]

Needle systems are illegal.....aren't they? I thoguht it was law by now. What compoany tubing are you using, surely then make an adapter.

I wished that type of tubing was illegal. I cannot count how many times I have went into a room and realized that I needed a blunt needle or one of those alligator clips. It is so annoying. I prefer the luer lock system, which those annoying little blunts and clips will be only a memory.

Re: phenergan.... I have known it to be given IV/IM/PO/IVPB

[keludtke]

I give phenergan IV all the time, very slowly, over 10 minutes, and mixed with at least 10 ml of NS, with good flushes before and after. Our hospital policy states we CANNOT give phenergan in hand or wrist veins due to the fact it can cause necrosis. So now a lot of the docs are ordering Zofran instead.

[10MG-IV]

from the pharmacy experts @ institute for safe medication practices:

action needed to prevent serious tissue injury with iv promethazine

ok, but don't take it away. its efficacy is huge!

learn how to give it correctly, like any other drug.

nurses teach your young.

don't eat them, it will leave a funny taste in your mouth.

[Babs0512]

We give IV Phenergan all the time. I've never diluted it, but I always give in with a wide open running IV and I push it slowly. I've never had anyone have a bad reaction to it in 16 years of nursing. I have, however, had several people become anxious, nasty, restless, shouting, etc... several times with Reglan. We give Benadryl, and the symptoms go away. I personally think Phenergan and Zofran work the best for nausea. That's been my experience anyway.

[nyemt195488]

I personally have been on IV phenergan off and on for the last 8 years. I suffer from non-diabetic gastroparesis and there are many times when I can not tolerate the PO phenergan. I have been on as much as 50 mg IV every 4-6 hours just to keep from needing a feeding tube. It does cause severe burning and has infact damaged a couple of my veins so now I have a mediport. The port is much nicer, no burning what so ever but I still have to push it very slowly as the port goes into the right atrium so if I dont go slow enough I feel the effect very quickly. Thankfully I carry a signed order from my gastro doc otherwise there are a few times I would not have been given it IV. Which would have left me unable to keep anything down as due to an absorption problem IM does not help, and suppositories just burn too much.

[ccuCCRN]

I've always given IV Phenergan. As everyone else has already written, make sure to dilute it. Otherwise, you are "good to go." :)

[beth318]

I might have missed something, but just tonight I have given several doses of IV Phenergan 25mg to various patients. As for using a needle to inject into the port, there is nothing wrong with it other than needleless systems are safer. You diluted it and you pushed it slow, nothing much else to it. i have only had one pt in several years have any reaction to it. It made her very anxious and basically mean, but then it wore off and she was normal again.

Just not worth your license to push this drug IVP! Risks are too High!

I just did a case study on phenergan for my pol. Sc. class, guess what nurses, we are incorrect about Phenergan!Just this march 2009, this case went to all the way to the Supreme Court. I was horrified to learn that all these years I had been giving phenergan Ivp as instructed by my policies at each of the facilities I worked in. I learned doing this research that if I push Phenergan iv push, as I am instructed to do by md's orders. I will be sued, if an adverse reaction occurs, Phenergan is so bad that if the iv get inflitrated and the drug enters into the tissue or artery, gangrene can and will develope. They will amputate the limb as far as they need to. Nurses be aware that phenergan is a very dangerous drug, do not ivp the drug, do not dilute it in 10cc normal saline, diluting it in 10cc is not safe enough, dilute it in 50cc - 100cc of saline and hand that bag. I can't tell you enought times do not ivp the drug, even if you flush the line or check it right before the push, you can't assume nothing will happen in those few second that you decided to push the drug that it was patent. We are mislead thinking we're going to alright pushing phenergan, don't do it! It just one time... the patient has the right and will sue the hospital, doctor who orders it, and YOU, and the patient will be right in doing so. By the way, she was mean because the you hurt her either because you pushed to fast, or the iv was inflitrated, phenergan hurts going in. Consider not pushing at all.