While I agree it is best NOT to close the barn door after the horse gets
out, I wonder why there has been no mention of declotting with NaHCO3. It is
cheap and should work. So if there is indeed few clotted PICCs then the pharmacy
should have 8.4% Sodium Bicarb at the ready for those few occasions.
i still think Fosphenytoin is the better answer, even in a central access
like a PICC, but if you can not win that battle now, at least there is an option
to pulling the line.
Tony West,
RN, CRNI
Healix, Inc.
Email: [EMAIL PROTECTED] or [EMAIL PROTECTED]
SMS:
[EMAIL PROTECTED]
Cell: 214-674-4848
In a message dated 1/9/2006 1:42:32 P.M. Central Standard Time,
[EMAIL PROTECTED] writes:
We had
some resistance as well...the pharmacy said that even though
there are
problems with infusing Dilantin via PICCs, out of all the
Dilantin doses
given IV, that only a few of the PICCs have occluded, so
the percentage of
all the doses causing problems is small. I see their
point, but tell
that to a family of a small child who has to go get
another PICC
placed! Anyway, we are in the process of putting in place
a data base
for our central lines and hopefully will have better
tracking in the
future. In the meantime, my IV team and IR staff advise
not infusing
IV Dilantin via PICCs. You would like a CVC due to the
high pH [like
Draino], but if it clogs the CVC, it is not worth it. We
seem OK via
non-tunneled and tunneled lines, but not PICCs. It is part
of our nursing
PICC instruction. By the way, we give our Dilantin IV as
an infusion,
mixed with saline, not as a push drug as most adult
hospitals
do....
Anne Marie
>>> "Cole, Darilyn - MET"
<[EMAIL PROTECTED]> 01/09/06 12:13 PM >>>
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
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