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Paul,
You must also remember that a lot of people do not realize that certain medications precipitate in the line and no matter how much you flush, they will not be completely removed. Dilantin is a drug that must be given in a dedicated line. Very incompatible with EVERYTHING. It is bad enough what happens giving it alone, but when you go giving it in a line that you are using for other drugs,such as heparin or vancomycin, no amount of flushing is gonna help. Nurses must be knowledgeable about the other drugs being used. They (nurses) also have a very bad habit of over or under diluting Dilantin and causing it to "fall out" of the solution and crystalize. PICC's are very small, and therefore it does not take much to occlude them. I always let the doc's know ahead of time that a triple lumen central line is a better option for Dilantin. At least they can dedicate a line specifically to the dilantin that way. It would be much easier all around if Dilantin could be pulled from the market and Fosphynitoin used in it's place. It is a much safer drug with a much safer and stable chemical make up. It's all about the almighty buck! As usual.
Heather Nichols RN BSN CRNI
Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Blackburn, Paul" <[EMAIL PROTECTED]> 3/23/2006 8:04 PM >>> Dilantin can be safely given through a PICC, it is just a matter of
technique. As dilantin has so many incompatibilities, it is essential to thoroughly flush the PICC prior and following administration of dilantin. We normally recommend a 10ml vigorous flush before and after infusion of dilantin. I personally recommend the use of 20ml saline flush before and after infusion of dilantin. I have spoken to many clinicians who use this regimen and don't have any issues infusing dilantin through a PICC. Paul Paul L. Blackburn, RN, MNA Manager, Clinical Education Office: 800-443-5505, ext. 4981 Mobile: 801-598-1657 Email: [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Murbach, Barbara Sent: Friday, March 17, 2006 8:29 AM To: [EMAIL PROTECTED] Subject: Dilantin through PICC lines 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 Confidentiality Note: The preceding e-mail message (including any attachments) contains information that may be confidential, protected by applicable legal privileges, or constitute non-public information. It is intended to be conveyed only to the designated recipient(s). If you are not an intended recipient of this message, please notify the sender by replying to this message and then delete it from your system. Use, dissemination, distribution or reproduction of this message by unintended recipients is not authorized and may be unlawful.
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