Dilantin Infiltration

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I have a delima! As a nurse of 15 years, I recieved some dilantin in my left hand after a seizure. The medicine immediately went into the tissue. Does anyone have any suggestions on how long it will take to heal, or has had any experience with the healing process. I have been at this for 4 months now and continue having the swelling, pain, numbness, weakness, and of course the purple glove syndrome. It makes work hard not having full function. I am told it can take up to a minimum of 12 months to heal if it does. I am lucky so far to not have sluft any tissue, but am still at risk they say? The good news is that because of me, our facility does not allow IV Dilantin use anymore!!!!!!!!! So if your facility is still using IV Dilantin, please talk to your Doc's about other alternatives (their out there). It you do have to use IV Dilantin please make sure that your IV site is intact, especially after your patient has experienced tonic, clonic activity!!!!!!! Also as nurses always check with your patient about any ALLERGIES, and always check their ALLERGY BANDS before giving any medications. I won the GOLD STAR for recieving a drug twice that was listed on my ALLERGY BAND, causing seizures, therefore getting the Dilantin infiltration. Please reinforce yourself and others, make it a habit to always check, even if the patients look at you like you are nuts, for asking the same thing 4 hours ago.

Would like more info,

Moho:rolleyes:

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Specializes in Nephrology, Cardiology, ER, ICU.

What a nightmare! I certainly hope you have gone the Utilization Review board with this mess. I work in a large ER and yes we do give IV dilantin - but only in large veins - NEVER EVER in a hand! (What were they thinking???) Also - while you can give phosphenytoin - its sometimes not as effective. Our docs also follow a lit review that stated loading dilantin po in patients who are already on it - is just as effective as IV. Take care and good luck.

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I agree with the previous poster..Dilantin in a hand!!?? Big no no!! Hope you are on the mend!! Erin

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I can empathize with you..I stuck myself accidentally with a needle full of Dilantin when I was a new grad and that hand was miserably numb and discolored for a good while. Hope you feel better soon. It took a few months for my problem to subside completely.

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Specializes in Step down, ICU, ER, PACU, Amb. Surg.

I would strongly recommend that you go see a plastic surgeon that is also a hand surgeon. Usually the antidoted Dilantin extravasation is Regitine there have also been studies in children using NTG paste. I do not know the particulars on the latter but it is something to doscuss with a medical professional to see if they have more info and insite.

Have you tried occupational/physical therapy with a registered hand therapist to build up your strength and mobility in your hand?? Registered hand therapists are out there and they are abistively posolutely fantastic. I credit a RHT with giving me back as much strength and mobility as I have after having had hand surgery. I would not be working as a nurse today if it was not for that woman.

As for having recieved Dilantin in the hand.....whom ever administered that to you should have started a large bore IV in a large vein, such as the antecubital or bigger. When I learned about Dilantin IV in school (many moons ago) and in any hospital that I have ever worked in, there was a policy for administering Dilantin IV and of course they should have made sure that your iV was still intact and patent before giving it to you. I don't think that a ban on IV Dilantin is the answer but rather staff education and the developement of a policy for the administration of Dilantin. Also if you are giving dilantin IV, the antidote should be readily available for just such an incident as yours, the IV cath left in so that the extravasation site can be flooded with a portion of the medication before the rest is given SC around the infiltrated site. There is also one other medication that is used but I can not remember the name.

Sorry to hear of your troubles and I hope you will be on the mend soon.

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I would call a lawyer. Allergic and had seizures after recieving medication I am allergic to?

I would not care who works where.

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:specs: Thanks for all the info and advise. I think I am on the mend but just when things look good, my hand swells and turns pretty colors and the pain is so much fun. I get the tylenol out and rest it. The hand specialist I seen did not recommend any PT just gentle lotion massage for now. He also said not to let anyone do anything to it (ie. test, needles, etc.) and leave it alone to rest and heal. Process with a minimum of 12 months. Oh yeh!

thanks again,

Moho

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Originally posted by nowplayingEDRN

I would strongly recommend that you go see a plastic surgeon that is also a hand surgeon. Usually the antidoted Dilantin extravasation is Regitine there have also been studies in children using NTG paste. I do not know the particulars on the latter but it is something to doscuss with a medical professional to see if they have more info and insite.

Have you tried occupational/physical therapy with a registered hand therapist to build up your strength and mobility in your hand?? Registered hand therapists are out there and they are abistively posolutely fantastic. I credit a RHT with giving me back as much strength and mobility as I have after having had hand surgery. I would not be working as a nurse today if it was not for that woman.

As for having recieved Dilantin in the hand.....whom ever administered that to you should have started a large bore IV in a large vein, such as the antecubital or bigger. When I learned about Dilantin IV in school (many moons ago) and in any hospital that I have ever worked in, there was a policy for administering Dilantin IV and of course they should have made sure that your iV was still intact and patent before giving it to you. I don't think that a ban on IV Dilantin is the answer but rather staff education and the developement of a policy for the administration of Dilantin. Also if you are giving dilantin IV, the antidote should be readily available for just such an incident as yours, the IV cath left in so that the extravasation site can be flooded with a portion of the medication before the rest is given SC around the infiltrated site. There is also one other medication that is used but I can not remember the name.

Sorry to hear of your troubles and I hope you will be on the mend soon.

:confused:

Thanks for the info. I did not know that Regitine could be used for Dilantin infiltrations. I thought it was used for Dopamine infiltrations. If it could be used, I sure wished our facility would have used it. I was at church last night and just clapping during worship service made my hand turn black and numb. My husband started praying for it and told me to stop clapping. I was holding my son in the ER Dept for an injury at school and it required stitches to his lip, but that's another story. Any how my hand turned a very beautiful dark purple just from sitting on the cart holding him on my lap. He weighs 50 lbs. The ER Doc turned his focus on my hand and away from my son. I reminded him what happened and he said "it still looks bad" after 4 months. This is not fun, but it is a timely matter that I will have to endure for a long time. Everyone just keep me in your prayers over the next several months.

thanks,

Moho:specs:

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Specializes in Step down, ICU, ER, PACU, Amb. Surg.

It's amazing what typing while being half asleep will do for a person, including putting the wrong info into type. You are correct in saying that regitine is the antidote for dopamine, not dilantin. However, your pick up on my error caused me to do a little digging around to see what I could come up with (the best cure to correct a mistake is to look up the info :) ) Regitine is also used to treat dermal necrosis in addition to extravasation injuries (which is an unlabled use). The literature that I looked through on Medscape does not specify what drug extravasation or cause of dermal necrosis it treats. So I would still say that it might bear looking into as treatment for your purple glove syndrome from dilantin extravasation. Now that I said that, I discovered the following article ( http://www.critical-care-nurse.org/aacn/jrnlccn.nsf/(Articles)/203CoverTitle?OpenDocument ) that suggests that there is nothing medicinally that can be done to treat the PGS except conservative treatments, such as dry heat at 98 degrees F and elevation. There was also this article: http://www.bnf.org.uk/bnf/bnf/current/openat/100049.htm which provided some good info. But again, nothing really that can be done except conservative management of the symptoms after the injury occurs.

Of particular intrest is the mention that Regitine is very limited in supply and facilities are only allowed to have it, if there is a patient recieving dopamine. There was rumor that Regitine was no longer being manufactured and then there was supposedly a company that was manufacturing it on a small scale. Again....a different topic for a different discussion and more research.

Hope that some of this has provided you with some help and I truely hope and pray that you are on the mend.

Christie

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Specializes in Jack of all trades, and still learning.

But I have a friend who takes oral dilantin for her epilepsy and she has developed peripheral neuropathy (confirmed by her neuro) as a result. Her medication was decreased, and the symptons did ease, but they have since returned. Any advice? Have you heard of this before? I have only heard of peripheral neuropathy with diabetic pts

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