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Tue, 06/10/2008 - 02:34

mary ann ferrannini

Dilantin extravasation.

What is the real answer here. In reviewing the literature there are varied opinions regarding the reccomendation for thermoregulative therapy in treating a Dilantin extravastion/infiltration. Some sources say cool and some say dry heat as warm moist heat may cause skin maceration. I think no one really knows for sure. Since the ph is 11-12 I am leaning toward cool to isolate the agent as opposed to spreading it out. Isn't Purple glove syndrome just a fancy name and a specific reaction to an infiltration of Dilantin. what are IV nurses really doing?. Also noticed on the PGS articles they said dry heat. Anyone ever seen any Corticosteroids given in this situation. Any help would be appreciated. I am aware of the recommendations regarding hyperosmolar,iso and hypotonic treatments . Thank you for your help

Tue, 06/10/2008 - 14:07

lynncrni

As you have found there is

As you have found there is no research to support the treatment of Dilantin. I would recommend using hyaluronidase as an antidote and cold treatment. Heat will make it worse by bringing the drug into contact with more tissue. Literature on extravasation states that steroids are not recommended. Yes, purple glove syndrome is the extravasation of Dilantin. Of course the best thing is to prevent this problem in the first place by using fosphenytoin or giving phenytoin through the smallest gauge catheter, never use an area of joint flexion, always ensure a brisk blood return and that the catheter flushes without any question using at least 10 mL of saline. That is the policy I have always used.

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

Tue, 06/10/2008 - 17:56

mary ann ferrannini

Thank you Lynn. We

Thank you Lynn. We encourage the MDs to switch to the fosphhenytoin,but they are very reluctant,stating cost issues and dosing issues. I bet you would not be suprised to hear that many nurses are unaware of the extravasation potential of this drug as well as how to administer it properly. I should not be shocked but I must state that at times I am!!! Quick question.......would the Hyaluronidase spread the drug out more potentially causing more damage or would this actually help by decreasing the concentrated level of it at a specific location. Also read said about a specific brand of Hyaluronidase being the product of choice as recommended by the World Health Organization and now I can not find where I read that. Do you know what brand this is. Thank you so much for your help you are awesome!!!!!!

Tue, 06/10/2008 - 19:17

(Reply to #3) #4

lynncrni

Hyaluronidase works by

Hyaluronidase works by breaking down hyaluronic acid in the subcutaneous tissue and allowing the reabsorption of the drug faster. Yes, I would totally believe the lack of knowledge of most nurses about all infiltration/extravasation issues! Sad, but true.

There are 3 brands of hyaluronidase now. Amphodase and Vitrase are animal derived products. Hylenex is a recombinant product. I have not seen what you are referring to from WHO, so not sure about that. Hylenex is marketed by Baxter.