Dilantin/Phenytoin Question

[UM Review RN, ASN, RN]

Have you ever given Dilantin IV push? How fast do you give it and what's the usual dose you give? Does the patient need any extra monitoring? Any precautions other than the standard Don't mix with D5 rule?

I ask because I usually give Dilantin as an infusion, not a push. (And way more Cerebyx than Dilantin.) Also, this was not my patient. The dose was 300 mg and came in 100 mg vials, so there were 3 vials.

I'm just curious. If it was my patient, I probably would've called Pharmacy and if I had to push over 100 mg, I'd most likely have asked for an infusion to be made up. (Remembering that I deal with mostly elderly cardiac patients.)

But maybe I'm all wet with that idea, so I'd be happy to learn more about this.

[sirI, MSN, APRN, NP]

Hi, AngieO

Here is a link in the Med Savvy forum:

https://allnurses.com/forums/f279/iv-dilantin-203184.html

[TazziRN, RN]

I was taught to push veeeeeeeeerrrrrrrry slowly (50mg/5 minutes) and have the pt on the monitor. If you see junctional beats, you pushed too fast.

[UM Review RN, ASN, RN]

Thanks, Siri and Tazz. The thread responses kinda confirmed that I would be very leery of pushing 300 mg through a peripheral to an elderly patient.

I wouldn't have thought to request a change to Cerebyx, however, so I'll file that away for future reference.

PS Guess this thread needs to be moved, eh?

[sirI, MSN, APRN, NP]

PS Guess this thread needs to be moved, eh?

Done.

[caroladybelle, BSN, RN]

Dilantin is very irrating to the veins and can cause serious tissue and/or nerve damage if it infiltrates.

The patient needs to be on a monitor.

[NurseRotten]

Dilantin IV can also cause Steven-Johnson Syndrome.

[jbp0529]

Just finding this thread now (sorry, I know it was posted back in may)

With my hospital's IV pumps, we have the ability to run primary and piggyback infusions at the same time. Therefore, with dilantin, we make sure we have a decent IV (20 ga or larger, or central line), draw up the med in a syringe, and attach it to the "piggyback" port on our IV tubing cassette, which we run concurrent with our primary IV fluid (NS). We run it slowly, like a prev post said, at about 50mg/min., and keep an eye on the EKG monitor. Also, we have a dedicated set of IV tubing/NS that we put in/out of the pump whenever the dilantin has to be given, so that any other piggybacks don't conflict with residual dilantin that may be left in the tubing.

Hope this helps

[tiij]

never ever a push. you can cause cardiovascular collapse. so you'd put it in a minumum of 50ml NaCl (dilute to 1 - 6mg/ml), preferbally infuse into a large vein. look out for hypotension. give over 30 minutes (unless its a loading dose) cheers.

[meandragonbrett]

We mix it up in a 60cc syringe and run it over 10 minutes or so. Our pharmacy says no more than 50mg per minute.