IV Dilantin

hogan4736, BSN, RN · Oct 21, 2003

are they not using IV Fosphenytoin anymore?

I used it quite a bit when I worked ER in the mid to late 90s...it can be given faster, and is converted to dilantin in the bloodstream...

sean

Tweety, BSN, RN · Oct 21, 2003

Originally posted by hogan4736
are they not using IV Fosphenytoin anymore?

I used it quite a bit when I worked ER in the mid to late 90s...it can be given faster, and is converted to dilantin in the bloodstream...

sean

I think some areas still have the sacred cow of Dilantin. I've seen fosphenytoin given, but not often.

Tweety, BSN, RN · Oct 21, 2003

Originally posted by grouchy
Yikes! Must proofread! Please ignore the typos. :-(

There is an edit button you know. But I rarely proofread and have it built into my sig, because I'm the champion misspeller and typo-er. :)

JustMe · Oct 21, 2003

I've seen Dilantin plug up a central line!! So I've ALWAYS started a wide open NS line and give the Dilantin no faster than 50mg/min also watching the pt's monitor and BP closely. If another IV solution has been running thru the line, I use my kelly's to clamp the tubing as close to the hub and piggyback the running saline line into the primary tubing. Let her rip for awhile to wash out the other solution, then start the Dilantin. Wash out the Dilantin after you're finished, disconnect the saline and restart your primary IV. Never had a problem after trying this technique.

nursemary9, BSN, RN · Oct 21, 2003

Hi

IV Dilantin can be tricky; I, too, as someone else said, run NS

concurrently. Then I give the dilantin very slowly & check for blood return VERY frequently. I flush with NS before and after. Dilantin is VERY painful when administered by peripheral IV. I, too, have seen it clog even Central lines.

I have seen extravasations from Dilantin and believe me, you never want to see another! The one I saw was far worse than one I saw from Adriamycin!!

In the new place I work, we give it in a small--50cc bag of NS.

I like this better.

Remember, It really is a very painful drug for the patient!!

ICUJeffro · Oct 21, 2003

I have to admit that it surprises me that IV Dilantin is being given. At my institution the hospital formulary automatically converts an IV Dilantin order to Cerebyx (fosphenytoin), unless ordered otherwise. Nothing was wrong with the method of administration, although I would ask the physician if Cerebyx would be an option.

Trauma Columnist · Oct 21, 2003

I work in ER and we routinely give 1gm or 500mg IVPB. What about diluting in NS (20cc) and giving per syringe pump over 15 minutes with filter?

nowplayingEDRN · Oct 21, 2003

Originally posted by ICUJeffro
I have to admit that it surprises me that IV Dilantin is being given. At my institution the hospital formulary automatically converts an IV Dilantin order to Cerebyx (fosphenytoin), unless ordered otherwise. Nothing was wrong with the method of administration, although I would ask the physician if Cerebyx would be an option.

When we have to give IV Dilantin we usually mix it up in a 100 cc bag of NS, flush the primary line through with NS and then hook up another line as close to the hub as possible and put the Dilantin runner through that line, running the NS concurrently to minimize discomfort. Although I have been fortunate in my nursing career to never have had a pt with a Dilantin extravisation, I know they can occur and thet they are nasty. I like Gwenith's analogy on the pH of Dilantin and she is just about correct in likening it to Drano....it burns like hell, especially in a peripheral line inserted in the hand or inner forearm. There is just no way around it but to give it slow and constantly assess the IV site.

ICUJeffro....

You would be surprised at how many doctors are not familiar with Fosphenytoin and yet how many hospital formularies that it is a part of. Prescribed in p.e's (phenytoin equivilants) which are equal to the same number of mg's of phenytoin......works the same way and is a whole helluva lot nicer on the veins.

NicuGal, MSN, RN · Oct 21, 2003

You can dilute Dilantin...we do for our little ones, but it has to be given immediately and not be laying around. Make sure your line is really flushed well or you will get crystals. I haven't sent fosph. given in our unit at all, but then again, neonates are a whole nother species

neneRN, BSN, RN · Oct 22, 2003

I'm surprised to hear that most don't dilute Dilantin further. We frequently give IV Dilantin in the ER, usually pts coming in after a seizure with subtherapeutic levels so the majority of the time we are giving a gram. We always dilute it in 250 cc NS and run it in over an hour. I've never had any problems giving it this way.

Tweety, BSN, RN · Oct 22, 2003

Originally posted by neneRN
I'm surprised to hear that most don't dilute Dilantin further. We frequently give IV Dilantin in the ER, usually pts coming in after a seizure with subtherapeutic levels so the majority of the time we are giving a gram. We always dilute it in 250 cc NS and run it in over an hour. I've never had any problems giving it this way.

I know you dilute loading does like 1000 mgs, but do you dilute in piggybacks the smaller doses like 50 to 100 as well?

150 mg's I would consider diluting in a piggyback I think, but I don't think I've ever seen that kind of dose routinely written, but the smaller doses we don't.

neneRN, BSN, RN · Oct 23, 2003

I don't think I've ever administered less than 500 Mg, but I would go ahead and dilute just about any dosage, at least into a 50 or 100cc NS bag.