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Wed, 03/04/2009 - 15:53

lynncrni

Phenergan case is settled by Supreme Court

Here is the link to the news article about the Supreme Court's decision in the case against Wyeth about their failure to warn about the hazards of IV administration of Phenergan (promethazine).
http://abcnews.go.com/TheLaw/SCOTUS/comments?type=story&id=6939486

This continues to be a dangerous drug for IV administration. It requires the same level of expert skill as any other vesicant cancer chemotherapy agent, yet most nurses do not realize what is actually needed to safely administer this drug IV. To read more about what that entails see my blog entry
http://hadawayassociates.blogspot.com/2007/06/promethazine-injuries-continue.html

Wed, 03/04/2009 - 20:14

momdogz

Here's the NPR

Here's the NPR link:

http://www.npr.org/templates/story/story.php?storyId=101443146&sc=emaf

Mari Cordes, BS RN

Nurse Educator IV Therapy

Fletcher Allen Health Care, Burlington VT

Educator, Bard Access Systems

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Thu, 03/05/2009 - 17:49

blodahl

I've been an RN for 39 years

I've been an RN for 39 years and a hospital IV nurse for 23 yrs. I've had extensive experience w/ IV phenergan. While some pt's maintain it is the only IV medication that helps their nausea, it is a nightmare to maintain healthy PIV access. Invariably, the PIV site must be changed every 12-24Hr, and each site ends up w/ some degree of phlebitis. If I had my way, it would be removed from PIV administration and be reserved for only central IV administration. I've read Lynn's blog and the "average" bedside nurse I run across is not usually competent or even willing to take the time to perform the level of IV site assessment described. Oncology certified nurses and CRNI's, yes, but not the average med/surg nurse. I've never personally seen or known anyone lose a limb to phenergan infiltration, but I've seen tons of thrombophlebitis (one from hand to armpit) and seen skin grafting required. I've heard diluting it doesn't alter it's pH, but merely helps to slow you down. I teach our nurses to avoid PIV administration as far as possible. Often interrupting N/V response w/ a dose or two of IV phenergan and getting the pt onto regular po or rectal suppositories dosing is successful. I don't want anyone injecting phenergan into my peripheral circulation! - No thanks!

Barbara

Thu, 03/05/2009 - 19:23

(Reply to #3) #4

lynncrni

I could not agree with you

I could not agree with you more! I have served as the expert on numerous legal cases involving this drug and have seen cases involving amputation. I think each hospital must examine their antiemetic protocols and eliminate the IV administration of this drug. I will always refuse to take it by the IV route.

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Sat, 03/07/2009 - 12:23

(Reply to #4) #5

lynncrni

I have thought more about

I have thought more about what you said about the average bedside nurse and their competency with giving promethazine. I agree that most do not know how or take the time to perform the steps as I outlined. But this means that they are not meeting the national standard of practice and therefore will be held accountable for the outcomes. Any nurse, regardless of where they work, who accepts the responsibiity for performing any infusion therapy task must meet the standard. If they are unable, unwilling, or do not have the knowledge and skill needed, then they should not accept the responsibility. I realize this is a hard approach, but it is true for all tasks, procedures or practices that nurses do. The entire education and practice environment sets up nurses for these problems because nurses are not generally taught much, if anything, about infusion therapy practices in nursing school. Then when they go to their first job, they are at the mercy of whatever method the hospital has for teaching them. If that hospital has no infusion team, then there is no emphasis on these invasive danger tasks. The new graduate is left to be taught by another nurse who may not have any formal background in infusion therapy knowledge either. So this is a never-ending, self perpetuating problem of very low levels of knowledge and skills. Something has to be done to change this situation!

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Fri, 03/06/2009 - 11:13

ann zonderman

Ann Zonderman, BSN, JD,

Ann Zonderman, BSN, JD, CRNI, LHRM

Just for the busy folks, bottom line - Patient 7million dollar verdict upheld

Court held that the drug companies can not stand behind FDA protection. If warningis are not sufficient ... or if things change, drug makers must step up warnings.

Ann Zonderman, BSN, JD, CRNI

Sat, 03/07/2009 - 10:25

Dan Cochran RN

I personally experienced IV

I personally experienced IV Phenergan administration over 20 years ago in the hospital setting. The PIV was in my right antecubital area, given undiluted (I think, I was very sick at the time), and I still have a basilic venous cord from AC to axilla. I remember the fireball-like feeling and pain to this day. I show this to the newer nurses I encounter to this day to reinforce the importance of proper medication administration.

Tue, 03/17/2009 - 09:32

CATHY RHODES

cathy rhodes Does anyone

cathy rhodes

Does anyone have any information regarding infusing vanco, zosyn or flagyl, through an peripheral IV? We are trying to get our facility to run ithese drugs through a central line. Most of our restarts for IV's are because of these drugs.

cathy rhodes

Tue, 03/17/2009 - 20:38

(Reply to #8) #9

Chris Cavanaugh

Regarding Phenergan, I

Regarding Phenergan, I personally stopped giving it IV years ago, every patient has a muscle, and it is much safer IM. If the patient complains, I have gotten orders for other antiemetics.

Cathy, have you tried using the INS standards for peripheral IV medications as a basis to change your policy for these drugs?

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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