We have a policy in place stating we are not to infuse Dilantin through our PowerPICC's because of precipitatiion and causing an untreatable occlusion of the line.
I'd like to know the experiences of other hospitals are you infusing Dilantin using a PowerPICC? Have you experienced any problems with precipitation?
Thank you for your time.
Dilantin is incompatible with ALL other solutions and I would never give it diluted in any solution. I have pushed lots of very large doses but it has always been with the drug undiluted in a syringe doing a very slow manual push, checking for a blood return every couple of mL and frequently asking for any compliants from the patient. This is a dangerous vesicant med! Many years ago there was concern about giving Dilantin through any catheter made of polyurethane, however those concerns were never verified through published research. This left lots of questions - is there an incompatibility between the drug and the polymer? Is there residual drugs attached to the intraluminal biofilm that can not be flushed out and this is what is producing the drug precipitate? I have seen an intraluminal precipitate occur inside a PICC, so know that it can easily happen even with the best flushing methods. Due to the problems with phenytoin (Dilantin), most facilities have now switched to fosphenytoin as the same problems do not occur with this new drug. That would be your best approach with the Pharmacy and Therapeutics committee and physicians. Precipitate occurs because the original pH of 11-12 has dropped. To reverse this pH change, instill sodium bicarbonate. Some have had success with this and others not. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861