# 一位護理師正準備以靜脈注射方式給予 promethazine 12.5 mg 處理噁心。哪一項給藥操作對於預防嚴重的組織傷害最為重要？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391790&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

一位護理師正準備以靜脈注射方式給予 promethazine 12.5 mg 處理噁心。哪一項給藥操作對於預防嚴重的組織傷害最為重要？

## 選項

1. 未稀釋，5秒內IV推注
2. 與KCl混合於Y-site輸注
3. 稀釋劑量，經大靜脈（最好中心靜脈）給藥，10-15分鐘慢速輸注，並監測部位是否浸潤 **✔ 正確答案**
4. 為避免IV併發症而改皮下注射

**正確答案: 3**

## 解析

正確選項 (2)：Promethazine 為 發泡性藥物；藥物外滲可能導致嚴重組織壞死、壞疽，甚至需截肢。ISMP 建議：稀釋至濃度不高於 25 mg/mL，經由通暢的輸液管路在 大靜脈（最好是中央靜脈） 中給藥，緩慢注射超過 10-15 分鐘，持續監測注射部位。手部注射部位為高風險。(1) 直接推注未稀釋的藥液是危險的。(3) 皮下注射途徑會造成嚴重傷害，屬禁忌。(4) 經 Y 型接口與 KCl 並用有不相容的風險。

## 深入解析

記憶提示 Promethazine IV =「大靜脈、稀釋、慢速、看部位」。許多機構已移除IV promethazine，較偏好IM或直腸替代。

## 臨床情境

情境 45歲女性，化療引起噁心；醫囑為promethazine 12.5 mg IV。目前可用通路：手部20號靜脈針。

## 重要概念

- **發泡性藥物** — 外滲時會造成嚴重組織損傷的藥物；如promethazine、升壓劑、化療藥。
- **外滲** — IV藥物意外漏到周圍組織；發泡性藥物可造成壞死。
- **IV promethazine安全** — 稀釋、使用大靜脈、慢速輸注、監測部位；考慮IM或直腸替代。

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