I need a reference to create a policy for Na Bicarb instillation to treat a dilantin precipitae. I have the new INS standards in front of me but the refences refer to tpa, ethanol and HCL.
The articles referenced in Standard 56, Practice Criteria F provide you with a discussion of alteration of pH by using either Na Bicarb or hydorchloric acid. These discussions are based in basic chemistry. Phenytoin has a pH of 11-12 or highly alkaline. Precipiate occurs because that high pH has dropped. To reverse the precipitate, you raise the pH with bicarb. I don't think you will find any actual clinical studies reporting the outcomes of the use of each solution. Lynn
I have only seen this in the Oncology Nursing Standards.
Chris Thomas
Do you have that standard?
The articles referenced in Standard 56, Practice Criteria F provide you with a discussion of alteration of pH by using either Na Bicarb or hydorchloric acid. These discussions are based in basic chemistry. Phenytoin has a pH of 11-12 or highly alkaline. Precipiate occurs because that high pH has dropped. To reverse the precipitate, you raise the pH with bicarb. I don't think you will find any actual clinical studies reporting the outcomes of the use of each solution. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861