Dilantin via PEG - stop TF??

[littlegreenfrog]

One more question:

When you give dilantin via a PEG with a patient who is getting continuous TF, do you stop the TF for an hour before/hour after giving the medication?

I had a patient in this situation, and I gave the 1500 dose of Dilantin without holding TF before/after and the patient vomited about 45 min later. When I told the charge nurse, she said that I should have held the TF before/after. I have never heard that before. When I asked the other nurses, some said to hold it and some said they had never heard that before and one said to hold TF for TWO hrs before and after.

This lady was getting Dilantin q8hrs and was only getting 45cc/hr TF - if I held it for one hr before/after that would be 6 hrs she would be off the TF and 260cc of TF she would not be getting.

Anyway, I of course was super busy and never got an answer and never had that patient again. I felt very badly if I had indeed made her vomit.

Please, what do you do when you have this situation?

Thank you, I am a relatively new nurse who works in chaos.

[catlvr]

We had a pt on tube feedings and dilantin...he was finally getting ready to go home after a six months in ltc, so I asked the doc to consider changing the dilantin to another med to simplify the feeding schedule for his family. Doc agreed, and started him on lamictal a few weeks before the pt left so that we could monitor him. It is little stuff like this that makes me feel as if I am doing my job properly, as it made things much easier for his family at home. And knowing how things work in ltc, it probably isn't a bad idea to get all tube feeding pts changed to another med if they can tolerate it - as this thread shows, there is a lot of variation in how the med is given and it may be safer for the pt to try something different.

[kids]

Since it affects absorption, I'd do whatever the norm has been since the dilantin was started. If all of the sudden you're holding the tube feeding, and the patient is used to getting the amount absorbed with the feeding going, then they're going to suddenly be getting a higher dose absorbed.

This.

I've seen it orders (and facility policies) that specifying NOT to stop the TF (in LTC/SNF) which can save a lot of time/hassle during med passes.

The rationale I've always been given is that since dosage is based on blood level it really doesn't matter if the feeding is held or not, just that however it's done is consistent.