04/25/2005

Promethazine injection has been added to our hospital’s list of vesicants (Policy 9-30. Extravasation of Non-Chemotherapy Agents, available online at http://intranet.uuhsc.utah.edu/policyLink/1981.html). Rare cases of serious harm have been reported occur when this drug is extravasated, including tissue damage and long-term sequelae.

Similar to other vesicants, the safest approach is to prevent promethazine extravasation whenever possible. Following these guidelines may reduce risk of extravasation or enable early detection when extravasation occurs:

• Use a newly-placed peripheral intravenous line. Avoid using existing peripheral intravenous lines.
• Administer promethazine injection through the largest vein possible.
• Flush the IV line with 5 – 10 mL 0.9% sodium chloride prior to administering the dose, to ensure vein patency.
• Give promethazine by IV sidearm, or slow IV push into the tubing of a line with running intravenous fluid. The infusion rate should not exceed 25 mg/minute.
• The promethazine concentration should not exceed 25 mg/mL.
• Observe the patient continuously while administering the dose.
• Flush the IV line with 5 – 10 mL 0.9% sodium chloride after administering the dose.
• Promethazine injection may not be mixed in the IV bag or given by a controlled infusion device. The risk of extravasation increases with longer infusion time. In addition, a longer infusion time makes it more difficult to observe the patient during administration.

There are no specific antidotes for promethazine extravasation. Instead, follow the general management guidelines given in the policy.