Actually, I have tried Sodium Bicarb twice with PICCs blocked by Dilantin precipiate, and could only get out a few small granules of stuff, but not clear the line. I think because PICCs are so small lumened, the NaHCO3 just doesn't get in contact with the precipitate. Anne Marie
>>> <[EMAIL PROTECTED]> 01/11/06 11:15 PM >>> 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
