# A nurse is preparing IV promethazine 12.5 mg for nausea. Which administration practice is most important to prevent serious tissue injury?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse is preparing IV promethazine 12.5 mg for nausea. Which administration practice is most important to prevent serious tissue injury?

## Option

1. Administer the dose as an undiluted intravenous push over 1-2 minutes through a small peripheral line, monitoring for any infusion site reactions.
2. Reconstitute in 50 mL of normal saline and administer as a secondary infusion over 30 minutes through a peripheral line to prevent infiltration.
3. Dilute the dose, administer through a large vein (preferably central), infuse slowly over 10-15 minutes, and monitor the site for infiltration **✔ Correct answer**
4. Administer the medication subcutaneously instead of intravenously to avoid potential IV complications such as phlebitis or infiltration.

**Correct answer: 3**

## 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.

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