dilantin

[bigmona]

Just curious how you give IV dilantin in your facility? The drug guide I looked in says you can administer 50 mg IV push over 2-4 mins and that you need a filter if you're going to infuse it. The vials themselves say "for IV (No Infusion) or IM use". However, when asking around at work, everyone says they just spike the dilantin into a small bag of saline and run it over half an hour to an hour. No filtered line. What do you do?

[NurseyBaby'05, BSN, RN]

If I add it to a bag, I draw it up with a filtered needle. Most of the time we push it through a central line. If it's a high dose, I put it in a mini-bag and run it over 30 min. My one man was on 400mg. I would have been pushing it forever. He had a port, so I wasn't so worried. I hate pushing it through hep-locks though since it's a vesicant.

[bigmona]

thanks! my patient had a port, too, and it was only 100 mg. Sounds like I could have pushed it in slow and been okay with that.

[NurseyBaby'05, BSN, RN]

Our educator told us it's actually better to push it when you can so you can flush it really well afterward. That way there's less chance of the med crystalizing in the line.

[kimartin0623]

IV Dilantin has a very short half life. It should be given over 30min using filtered tubing. Also it should be given via central access because it is a vesicant. i hope this helps,

[Rabid Badger, BSN, RN]

Yes I give it in a 50cc minibag through a filtered line. Give a generous flush afterward so the dilantin doesn't crystalize and cost you $1K in tPa to recover the line.

[Anagray, BSN]

We do not push dilantin on our floor and I am very happy about it. When I infuse dilantin I do it ONLY with a filter and ONLY on a very good line and ONLY with at least 25 cc flush. I have seen many horrible, horrible dilantin infiltrates coming to us from ED and ICU - I am not sure why they happen there so much.

[neneRN, BSN, RN]

We do not push dilantin on our floor and I am very happy about it. When I infuse dilantin I do it ONLY with a filter and ONLY on a very good line and ONLY with at least 25 cc flush. I have seen many horrible, horrible dilantin infiltrates coming to us from ED and ICU - I am not sure why they happen there so much.

Maybe because in the ER we are frequently giving doses of 1000mg as a loading dose; that's a big dose that we typically give over an hour. (Not that it justifies infiltrates, the site should be being monitored closely-but that's the only difference I can imagine between ED and floor)

[TeresaEDRN06]

I just wanted to add that in our ED, we make sure the pt is on a monitor, since it can lower blood pressure. We infuse it using a pump, as well.

[VickyRN, MSN, DNP, RN]

Pt definitely needs to be on a cardiopulmonary monitor. Can cause ECG changes. Saw a patient receiving a dilantin (phenytoin) infusion go from NSR to a wide-complex ventricular rhythm, with level of consciousness changes. (Of course, I immediately discontinued the infusion and reported this adverse effect to the physician.)

Also, if at all possible, ask primary if intravenous fosphenytoin can be substituted for phenytoin - much safer.

http://www.clevelandclinicmeded.com/medical_info/pharmacy/novdec2004/fosphenytoin.htm

http://professionals.epilepsy.com/page/managing_phenfos.html

[Roy Fokker, BSN, RN]

Had a port clog off (dual lumen PICC - other port was running TPN) the other day because nurse forgot to take away his PCA pump button.

You can add Dilaudid to the list of things that will mess up Dilantin I guess

[pawashrn]

the infusion/iv push of dilantin/na-bicarb good assessment at the beginning, during and at the end of the infusion Dilute and give slowly any medication when possible. It is always easier on the patients vessels