Daphne BroadhurstDesjardins PharmacyOttawa, Canada
Daphne is absolutely correct! I have always given Dilantin by IV push, even the large loading doses of 1 gram. Yes, this takes a lot of nursing time, but it is the safest method. Our pharmacy followed the manufacturers instructions about not diluting this drug. This is a vesicant med, so requires strict attention if giving it through a PIV. Many years ago, in the early days of PICCs there was the idea that Dilantin was incompatible with the silicone catheters. This was never proven and the actual incompatibility may be between the previous medications that adhere to the fibrin/biofilm that will be present in all catheter lumens. No amount of saline or flushing technique will remove this layer once it is present. Then you give Dilantin and the precipitate forms.
Our policy for giving through a PIV was to use only a dedicated PIV for Dilantin, flush with at least 10 mL before and after, a strict adherence to a brisk blood return from the catheter before giving, and no use of hand veins or veins in an area of joint flexion. We also worked to get the order changed to PO or now Fosphenytoin ASAP. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
At our hospital we have dedicated one port of the PICC to Dilantin use only, using only saline as IV fluid and saline flushes if the port is capped. In the real world that is not always possible. But when we were able to do so we were able to give Dilantin with little problem.