Dilantin is incompatible with all other drugs including saline in
some admixtures. This team may have seen a high number of PICCs
occluded from drug precipitate of Dilantin, thus their policy to
avoid it. Not a lot published on this problem but it is very real. It
may be caused by lack of or poor flushing practices or there could be
drug attached to the fibrin/biofilm complex that can never be flushed
out.
The flip side of this issue is that the pH of Dilantin is ~12 which
means it should not be given through peripheral veins. So you are
caught between a rock and a hard place! Any chance that your hospital
would switch to fosphenytoin that does not have these issues of
compatibility and is not a vesicant? Lynn
At 7:29 AM -0800 3/17/06, Murbach, Barbara wrote:
We were just informed that our PICC team is advising our ICUs that
Dilantin cannot be infused through a PICC line, does anybody have
any literature that supports this? We can't figure out their
rationale but would like to respond to the nurse's questions with
documentation/evidence. Thank you in advance for your help.
Barbara Murbach, RN, BSN, CRNI
TPN/CVAD Clinician
Loma Linda University Medical Center
Loma Linda, CA
909-558-4000, ext. 42381
pager 5509
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Lynn Hadaway Associates, Inc.
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