IV Dilantin

  1. I gave Dilantin IV to a patient the other day. He had D51/2NS going through his IV, and since Dilantin isn't compatible, I had to stop the IV and give the Dilantin through his saline well. I'm still a new grad in training, so I asked my preceptor how to administer it (I knew there were precautions, but not sure what) and she told me to just push it slow (150mg over three minutes). Well, after about two minutes and only 25mg given, the patient started howling and saying his whole hand was burning... If I run into this situation again, how should I administer it? What was I doing wrong? Thanks!
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    About LINUS

    Joined: Jun '03; Posts: 25


  3. by   Tweety
    The rate of administration is 50 mg/min. You might try mixing it in a bag of NS to dilute it, but depending on who you ask it's not recommended to be diluted. You didn't do anything wrong, it burns like the dickens and isn't recommended to be given IV peripherally. Ideally you should get an order for p.o. asap.

    Make sure your using a large bore saline "well" (we call them 'hep locks' here) and make sure there is a good blood return and go slow and stop if a patient complains of burning and give the patient a break.

    I hate giving IV Dilantin through a peripheral line because every complains.
  4. by   SharonH, RN
    I pretty much concur with Tweety said. I've always been told not to dilute it at all. You were certainly pushing slow enough. Whenever I push Dilantin through a peripheral line, I always check for a blood return after each 25mg and then I flush with about 5 cc of NS, and then resume that pattern until it is all in. Dilantin is a vesicant meaning that it will corrode the tissues if it infiltrates so you can't be too careful. But from what you are saying, I don't see where you did anything wrong.
  5. by   gwenith
    Dilantin has the Ph of Drano about 12!!! You could use the stuff to unclog the sink!

    The reason why it is not recommended to dilute it is that it can and does rapidly form crystals in the solution and if you dilute it you should give it through a filter. Usually the crystals are microscopic but if they are left in the burette long enough you can see them. (And how much does the patient get of THAT dose???)

    Dilantin can be given with a concurrent saline flow to reduce the irritation. Oh!! And never, ever give it with KCL - can we say concrete??

    Be in nursing long enough and you will see all sorts of problems
  6. by   Tweety
    I've seen the larger doses made into piggybacks, but they must be used immediately, but check your hospital policy. 150 mg is A LOT to be given IV peripherally.
  7. by   Paige Turner RN
    And, be careful of purple glove syndrome.................
  8. by   sharann
    Paige, remind me of purple glove syndrome, haven't heard that since nursing school. Is this circulatory or something else?
  9. by   Paige Turner RN
    soft tissue injury related to IV administration of Dilantin. We just had a patient that had it. I googled it and found several good articles.
  10. by   grouchy
    I used to be an oncology, so I was experienced in giving vessicant chemotherapy. Strangely enough, I've seen more problems from Dilantin than I have from vessicants! I always wonder if that's just been my personal experience, or how common Dilantin problems are. I have seen the purple glove syndrome - a woman whose hand was edematous and purple/black from a Dilantin extravasation. I saw it early in my career, and it made a big impression on me. So, now I really assess the IV site, and blood return very cautiously prior to giving it, I usually push it slowly through a free-flowing NS IV - clamp, push, let the saline flow, repeat, check for blood return halfway through and at the end, assess the site throughout, just like giving chemo.) I advocate for po Dilantin when appropriate. I also keep in mind what I learned as a chemo RN; i.e. the worst place to give a vessicant is somewhere that it's difficult to do a plastic surgery repair - that is, the hand would be worse than the forearm. So I'm more cautious, and more aggressive about changing iffy sites if they are in the hand or wrist. On the bright side, I've only see the purple hand thing once in over 10 years, and mostly I've just seen complaints of burning. I'm just a worrywart, but it doesn't hurt to be cautious.
  11. by   grouchy
    Yikes! Must proofread! Please ignore the typos. :-(
  12. by   Paige Turner RN
    what typo's???????
  13. by   LINUS
    You have all been so great! Thank you so much for the helpful hints! I feel much better now.
  14. by   hogan4736
    are they not using IV Fosphenytoin anymore?

    I used it quite a bit when I worked ER in the mid to late 90s...it can be given faster, and is converted to dilantin in the bloodstream...