A nurse is preparing IV promethazine 12.5 mg for nausea. Whi… | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A nurse is preparing IV promethazine 12.5 mg for nausea. Which administration practice is most important to prevent serious tissue injury?
1IV push undiluted over 5 seconds
2Mix with KCl in a Y-site infusion
3Dilute the dose, administer through a large vein (preferably central), infuse slowly over 10-15 minutes, and monitor the site for infiltration✓ Correct answer
4Administer subcutaneously to avoid IV complications
Explanation
Correct (2): Promethazine is a vesicant; extravasation can cause severe tissue necrosis, gangrene, and require amputation. ISMP recommends: dilute to 25 mg/mL or less, administer through a free-flowing line in a large vein (preferably central), slowly over 10-15 minutes, monitor the site continuously. The hand site is high-risk. (1) Push undiluted is dangerous. (3) SC route causes severe injury and is contraindicated. (4) Y-site with KCl risks incompatibility.
In-depth explanation
Memory Tip Promethazine IV = "Big vein, Dilute, Slow, Watch site." Many institutions have removed IV promethazine; IM or PR alternatives preferred.
Clinical scenario
Scenario 45-year-old female with chemotherapy-induced nausea; provider orders promethazine 12.5 mg IV. Available access: 20-gauge IV in hand.
Key concepts
Vesicant — Agent causing severe tissue damage on extravasation; promethazine, vasopressors, chemotherapy.
Extravasation — Inadvertent leakage of IV drug into surrounding tissue; can cause necrosis with vesicants.
IV promethazine safety — Dilute, use large vein, infuse slowly, monitor site; consider IM/PR alternatives.