I have seen this reference and think it was written by someone with
no real knowledge of infusion therapy and vein anatomy and the need
for hemodilution. I can understand or agree with their rationale and
think it is way off base, especially since they have no data to
support this.
The pH of phenytoin is extremely high, around 12, and this causes
cell protein damage when it extravasates.
I would always use the smallest gauge possible, prefer a catheter
that is less than 24 hours with a great blood return, and no signs of
any complications whatsoever. I would require a flush with a minimum
of 10 ml before giving phenytoin to do an adequate assessment of the
site. A 2 to 3 ml flush may not be enough to really detect the saline
in the tissue. I would require that this drug be treated with the
same techniques as any vesicant antineoplastic drug.
Lynn
At 1:15 PM -0500 2/8/06, [EMAIL PROTECTED] wrote:
Hello everyone,
One of our pharmacists and I are working on justification for fospheyntoin in
our facility. I noticed in a reference of his:
Archives of Internal Medicine/vol159, Dec13/27,1999 Guidelines for
Nonemergency
Use of Parenteral Phenytoin Products. ---the authors are recommending dry heat
application for phenytoin extravasations. They also state: "Continued
administration through the same vein or use of a catheter size smaller than
20gauge increases the risk of vascular injury and soft tissue damage."
1999 is an older reference but the recommendation is not footnoted.
What is your
practice with regards to treatment of extravasation and also cannula size to
prevent complications?
Jose
--
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
