Forgot to use filter with IV dilantin

[noodlenurse]

How important is it to use a filter with IV dilantin? When I searched this on the internet it looks as if you can sometimes give it without a filter.

Heres the story: My patient had a central line and I used a locked port. I really have no idea why I did it, I have never forgotten to use a filter before. I pushed at an appropriate rate and gave about 100mg of a 200mg dose before I realized what I was doing. I tried to speak with my charge nurse about it but she was unavailable because our floor got hit hard. It was at the end of my shift and I asked another nurse who didn't know what it would do. When I realized what I did, I immediately removed the syringe and flushed with NS. I then gave the rest through a filter. I am sure that as with other things, now that I have done this and freaked myself out about it, I will never do it again! However I worry that I could have caused my patient harm.

Anyone do this or know what pushing dilantin without a filter can do? I know it can be unstable in IV fluids, However there really wasn't any other than what was locked in the line and what I flushed with. I wonder if I should have aspirated what was left in the line before flushing it. Hopefully since it wasn't a peripheral line it didn't do anything. Wouldn't it be great to be perfect and never make mistakes?

[MQ Edna]

According to Davis' Drug Guide (8th edition) Phenytoin direct IV does not require a filter. Phenytoin mixed with NaCl and infused requires a filter.

Despite what the drug book says, the facility I work at requires a filter for both direct IV and infusion of Dilantin. We are not permitted to do an IV push with doses larger than 100 mg, and can only push dilantin with patients on continuous monitoring. Our policy also states that Dilantin should not be given through central lines unless there is absolutely no other IV access because the caustic nature of the product can cause corrosion of the central line itself. If Dilantin must be given through a central line, a flush of 10cc of NaCL is to be administered before and after the dose.

I don't think your forgetting to use a filter for an IV push put the patient at harm, my understanding is that the filter is in place to "catch" any precipitate that might occur when Dilantin is mixed with saline and infused over time. Otherwise I would check to make sure you are administering Dilantin according to your hospitals protocol, including use in central lines.