I talked to our physicians and our pharmacy department, first pointing out that every time we had a patient with a PICC who was getting Dilantin, it eventually plugged up. Usually not all at once. It seemed to be a cumulative effect, little crystals filling the end of the line and stopping it up. I also used a line I got from Kathy Kokotis referring to the vesicant properties of the drug. Basically, when they get you on the witness stand, and ask you why you injected this patient with a vesicant that damaged their arm instead of the innocuous Fosphenytoin, you better get ready to write a big check. I managed to get IV Dilantin off of our formulary.
Jerry Bartholomew RN BSN CRNI Vascular Access Specialist Veterans Affairs Medical Center Spokane, Washington -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Cole, Darilyn - MET Sent: Monday, January 09, 2006 9:13 AM To: Venous List (E-mail) Subject: Dilantin I am revisting this topic because of an ongoing problem with dilantin precipitates in our picc lines. I want our pharmacy to stock fosphenytoin, they say it too expensive and that the problem is strictly a nursing issue. What I need to know is how have you addressed this problem in your facility. It would also be helpful to have some article references that I can pass on to the Pharmacy and Therapeutics committee on the general safety of fosphenytoin vs phentoin. Thanks in advance, Darilyn Cole, RN CRNI IV Therapy Dept. Methodist Hospital 7500 Timberlake Way Sacramento, CA 95823
