Promethazine

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marcus2011

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I've read around that some people actually hang this by mixing their dose in a 100cc bag of NS when using a peripheral IV site...anyone else do this? Our protocols state that we can give 12.5 to 25mg without medical control but it must be diluted and slow IVP. Whats your protocols on this and some other caustic drugs?
 
You carry 100mL bags of NS on trucks?

I always mix it with 9-10mL of NS drawn out of bag into 10mL syringe, and give it slow with IV running wide open. Pinch tubing, push 1mL from syringe, run IV for 15-30 seconds, do it again. Never had a patient tell me that it burns or hurts.
 
Yeah we carry 100ml bags for epi drips and also cardiozem mixing. I'm used to pushing it in the ER where they just dilute it in 10ml of NS but I have heard some on the back of the truck hang it in 100 of NS
 
Most anything that needs a "slow" push goes in a 100ml bag of NS. Amiodorone, Mag, D50 in that person with teeny tiny veins...
 
I haven't used promethazine. But I just wanted to add the opinion that most people's "slow" push, using a syringe, seems to be about 10-20 seconds longer than their rapid push. Most people (including, unfortunately myself), I've seen giving slow push meds in EMS, have been giving them much faster than "over a couple of minutes".
 
Thats the main thing I was looking at. Suggestion is five minutes for 25 mg of promethazine in our system so hanging a drip would be way easier. Just wanted some opinions on it to do it or not
 
Very true. I'm also guilty of the fast "slow" push. If I'm going to push a med slow and not mix it in a bag, I count to 30 as I push each ml. For example, 20mg of Cardizem can take me 2 or so minutes.
 
Thank you all I will talk to my medical director on this and see what he says
 
marcus2011 said:
I've read around that some people actually hang this by mixing their dose in a 100cc bag of NS when using a peripheral IV site...anyone else do this? Our protocols state that we can give 12.5 to 25mg without medical control but it must be diluted and slow IVP. Whats your protocols on this and some other caustic drugs?
Click to expand...

Promethazine can cause horrible phlebitis if you're not careful. We mix ours in a 10cc syringe and give 6.25mg increments through a free flowing line usually. Using a 100cc bag isn't a bad idea at all, but doesn't necessarily have to be required.
 
Not only phlebitis, but it can cause anticholinergic syndrome if given rapidly.
 
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