RE: Dilantin

[Leigh Ann Bowe-geddes]

Title: RE: Dilantin

Agreed. Heather has worked to get our ER to use fosphenytoin for the first dose there, giving us time to place a PICC or short term CVC for future dilantin. Our pharmacy does not support the use of fosphenytoin completely as replacement for dilantin because of the price. I know, price and cost are two different things, and price should not be the determining factor for patient care, but she has made great progress just getting to this point. Dilantin is well absorbed via GI route, so we get it changed to po or enteral route ASAP. Leigh Ann    Leigh Ann Bowe-Geddes, RN, CRNI IV Therapy Specialist Infusion Services Department University of Louisville Hospital Louisville, KY 502-562-3530 >>> Lynn Hadaway <[EMAIL PROTECTED]> 02/04/06 1:19 PM >>> I would prefer to use a much safer approach and change to fosphenytoin. Or if forced to give Dilantin, I would much prefer a manual slow push rather than a piggyback with any form of dilution because the drug manufacturer does not support the use of dilution. Lynn At 9:15 AM -0800 2/4/06, Bev and Tim Royer wrote: I think I may have a solution and it may help.  Still looking into it with my Pharmacist.   We all know that Dilantin starts to crystalize as soon as the pH drops.  My theory is:     If we immediately flush with a mild strength (I do not know what will work yet) immediately afterwards that should dissolve and crystals that might have formed and clear the line.  (NaCHO3 is the solution indicated for Dilantin obstruction of a line.)  Then flush with 20ml of normal saline it should work.  We could hang a piggy-back to a piggy-back of Dilantin so that it immediately starts to clear the line after the piggy-back Dilantin finishes.  This way if the floor nurse is distracted (everybody knows that they are extremely busy) the line could be saved.     Two main Questions to this procedure.         1.    How much NaCHO3 is enough or what strength?         2.    Is the right amount enough to alter the patient's chemistry enough to be dangerous?   These off the wall things float through my mind all the time.   Timothy Royer, BSN, CRNI From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Leigh Ann Bowe-geddes Sent: Saturday, February 04, 2006 5:35 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: Dilantin Nancy: Dilantin is very prone to precipitation. It is not compatible with anything except NS. Flushing is very important, but there is another issue. The lumen through which the dilantin is infused should be dedicated to dilantin and NS only. Some of the drug may cling to the internal lumen, and if anything other than NS is infused between dilantin doses, you get dilantin crystals in the line. There are some other issues with dilantin. It is very important to flush well, and to administer the medication properly. It is not stable if the pH is allowed to drop, and the normal pH of dilantin is very high, somewhere in the 12-13 range. Leigh Ann   Leigh Ann Bowe-Geddes, RN, CRNI IV Therapy Specialist Infusion Services Department University of Louisville Hospital Louisville, KY 502-562-3530 >>> "Nancy Sullivan" <[EMAIL PROTECTED]> 02/03/06 8:26 PM >>> I know you ladies and gentlmen have probably discussed this many times, but I'm new to these message baords and have a  questions.   My hospital has a policy that states: "DO NOT INFUSE DILANTIN THRU PICC LINES." I have been working at this hospital for 3 years and it does seem like every time a nurse puts dilantin into a picc--occlusion and loss of the line.  I have been told that it is a flushing problem and lack of education. We use groshong  and per q cath piccs. SO PLEASE EDUCATE ME IN THIS MATTER, BECAUSE I WOULD LOVE TO EDUCATE THE REST OF THE STAFF. Thanks in advance Nancy Sullivan RN   Yahoo! 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