[smahccrn]

Does anyone out there know if there is definitive guidelines for administering dilantin via PICC lines. There is some literature about it that says "no" and some that say "yes" and some that say only if you have no other choice. I understand that it precipitates very readily in PICC's and wonder if it's and old recommendation? Anyone?

[oMerMero]

Hmm, I have never heard that before. I would think as long as the PICC line is flushed with NS before starting the dilantin it would be ok. Dilantin is one of those drugs that has to be given in NS and with a filter. After the dilantin is given, the line needs to be flushed with NS again to make sure all dilantin is out.

[iluvivt]

we basically avoid giving dilantin through a picc. because the lines are longer than other CVC's there is a much longer distance for mixing to occur even though priming volumes are usually smaller. Unfortunately,no matter what we have done including repeated training (i.e. use NS before and after,using a .22micron filter if in a mini bag) has helped ,we eventually lose our line and have to exchange or re-site. Remember that Dilantin has a ph of 12 (draino has a ph of 12). Giving it through a short peripheral is an option ----just monitor for infiltation /extravasation. Also a chest line is good also---do not forget adequate flushing with 10 mls NS before anf after----keep post flush same rate as push rate or pt could experience bradycardia. my favorite solution is Fosphenytoin ---compatable with D5W but it is costly. by the way Peds has banned the use of Dilantin through PICCs as long as I can remember hope this helps......if you continue to practice this ..you will lose your PiCC. I just re-did one 2 days ago

[GailAnne]

Dilantin and silicone PICCs are a problem (can't speak for polyurathane ones). I've seen them turned to cement with one dose, regardless of flushing, when a minibag is used.
If you MUST use the PICC, give the Dilantin push with extra saline pre and post (not just a paltry 5cc, I'd say at least 20cc).
Phosphenytoin sure sounds like the way to go, can't remember the ph of it. Unfortunately, there may need to go to litagation a few times over extravagastions before bean-counters decde cost isn't a factor!
Gail-Anne