Preventing serious tissue injury with intravenous promethazine (phenergan).

Vol. 34 No. 4 • April 2009 • P&T® 175 Severe tissue damage can occur regardless of the route of parenteral administration, although IV and inadvertent intra-arterial or subcutaneous (SQ) administration results in more significant complications, including burning, erythema, pain, swelling, severe spasm of vessels, thrombophlebitis, venous thrombosis, phlebitis, nerve damage, paralysis, abscess, tissue necrosis, and gangrene. Sometimes a surgical intervention, such as fasciotomy, skin graft, and even amputation, has been required. The true extent of the problem may be unknown, but it appears that patients are being harmed more often than is commonly recognized. Scores of reports have been submitted to the ISMP, the U.S. Pharmacopeia, and the Pennsyl vania Patient Safety Reporting System. Articles in professional literature; news of lawsuits in the media; and communications on various Internet listservs and message boards (ISMP, the National Patient Safety Foundation, http://allnurses.com, and others) have also been prevalent. The following scenarios were brought to our attention at the ISMP: