FW: RE: Dilantin

[ninaelledge]

Does anyone have figures on the AWP of these drugs?

 

Nina Elledge, RN, CRNI, MBA

 

-------------- Forwarded Message: --------------
From: "Heather Nichols" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED], "Leigh Ann Bowe-geddes" <[EMAIL PROTECTED]>, [EMAIL PROTECTED]
Subject: RE: Dilantin
Date: Mon, 6 Feb 2006 13:14:58 +0000

Amen!  I feel the same way.  People say fosphenytoin is too expensive to give here in our facility, when you can give Dilantin, but Dilantin is not the best drug of choice for the patient.  It has very real and dangerous side effects that can be avoided if fosphenytoin is given instead.  Again, people will find this out and the law suites will start.  Then it might change.  Hopefully.

 

 

Heather Nichols RN BSN CRNI
Infusion Services
University of Louisville Trauma Institute
530 S. Jackson St.
Lou. Ky. 40202
(502)562-3530

>>> "Kokotis, Kathy" <[EMAIL PROTECTED]> 02/05/06 9:09 PM >>>

Dilantin is in some ways not even compatible with normal saline or your bloodstream

Normal saline pH 5.5
Bloodstream pH 7.35
dilantin pH 12-14 but if it falls  below 10 it precipitates.  Both blood and normal saline make the pH fall below 10 so therefore you will find crystals of dilantin in the lungs if it does not preceipitate sooner.  Are we not lucky the lungs are a great filter of life

Kathy

________________________________

From: [EMAIL PROTECTED] on behalf of Leigh Ann Bowe-geddes
Sent: Sat 2/4/2006 6:34 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


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