Precipitation of free phenytoin occurs at pH of 11.5 or less The trissels I used is 1996 but the drug has not changed in that time period Trissels 2001 1052 pg makes the same statemens Out of trissels ninth edition pg 881 (the only one I had on hand right this minute) Blood has a pH of 7.35 Normal saline 5.5 Go to compatibility info and you will see visible crystals can occur in 10 minutes to 30 minutes in 0.9% sodium chloride. It is better to use 0.45% by the way as that takes at least 6 hours or more. (page 882) Baumann et al suggested that at a concentration of 1mg/ml the critical pH for aqueous stability is 10 (pg 886). The pJ of phenytoin 1 mg/ml is exactly 10 (pg 886). Therefore if it falls below this pH it is unstable and precipitates. What do you think happens if the blood flow is slow, the VAD tubing small, the distance to the SVC far. Think about it. It is not rocket science there is some particulate matter that forms and that matter ends up in the lungs. Kathy
________________________________ From: Lynn Hadaway [mailto:[EMAIL PROTECTED] Sent: Mon 2/6/2006 7:42 AM To: Kokotis, Kathy; Leigh Ann Bowe-geddes; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: Dilantin Kathy, I must ask for your reference for this information. Please provide it or tell us where you are getting this concept. Thanks, Lynn At 7:09 PM -0700 2/5/06, Kokotis, Kathy wrote: >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 > > >________________________________ > >Yahoo! Mail ><http://us.rd.yahoo.com/mail_us/taglines/virusmail/*http://mail.yahoo.com> >- Helps protect you from nasty viruses. > > >----------------------------------------------------- >Confidentiality Disclaimer > >This message, including any attachments, is confidential, intended >only for the named recipient(s) and may contain information that is >privileged or exempt from disclosure under applicable law, including >PHI (Protected Health Information) covered under the Health >Insurance Portability and Accountability Act (HIPAA) of 1996. If >you receive this message in error, or are not the named >recipient(s), please notify the sender or contact the University of >Louisville Health Care I.S. helpdesk at 502.562.3637 to report an >inadvertently received message. -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861
