RE: Dilantin

[ninaelledge]

HI listserv:

 

Trissels also recommends prep immediately before infusion, infusion within 1 hour, and use of an inline filter. LR is also an acceptable diluent.

 

Nina E.

 

-------------- Original message --------------
From: "Kokotis, Kathy" <[EMAIL PROTECTED]>

> 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
> >
> >
> >________________________________
> >
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>
> --
> 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
>
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