Wednesday, February 22, 2012

Tidbit: IV Dilantin

Administering IV Dilantin is one of those things you probably won't encounter very often (unless you work in the ER), but when you do, there are a few important things to remember.

  • Dilantin is a caustic vesicant and can cause extensive tissue damage if it extravasates.  It should not be refrigerated or diluted for long periods because it crystallizes rapidly in solution. Doses of 500mg or more can be diluted in 50 cc NSS or 0.45% saline if administered over 30 minutes.
  • NEVER give it with IV potassium because an instant precipitate will form in the IV catheter.
  • Make sure you have a patent, wide-bore IV site.  If you can't get a blood return or if there's any question as to whether the line is venous or arterial, don't take chances, start a new venous line.  See picture below.  Purple Glove Syndrome is catastrophic tissue damage caused by Dilantin extravasation.
  • DO NOT ADMINISTER through a PICC line as it is more likely a precipitate will form and occlude the line.
  • If you're running fluids other than normal or half-normal saline, flush the line with at least 10cc of saline before administering Dilantin.  Dilantin is compatible with normal saline or .45% saline only.  It is NOT COMPATIBLE with dextrose solutions.
  • Administer slowly -- no more than 50mg per minute (25mg per minute in elderly patients or those with cardiac disease). It will probably still burn.  Rapid administration can result in cardiovascular collapse, CNS and respiratory depression, and severe hypotension.  Loading doses of 500mg or more should be administered on a pump.
  • Be sure to flush the line thoroughly with saline when you have finished administering the dose to prevent irritation to the vein and to wash the IV catheter clean before connecting other fluids.
  • Patients receiving IV Dilantin should be placed on telemetry monitors because of the risk of depressed cardiac conduction, ventricular fibrillation and heart block.

Purple Glove Syndrome related to Dilantin extravasation.

2 comments:

  1. I went to a hospital in Calgary, Alberta,they accidentaly they put phenytoin IV straight through my PICC line which was directly in an artery close to my heart, now should they have went in my vein? Because I felt hot and sweaty, almost like I was going to have a heart attack.

    ReplyDelete
  2. I went to a hospital in Calgary, Alberta,they accidentaly they put phenytoin IV straight through my PICC line which was directly in an artery close to my heart, now should they have went in my vein? Because I felt hot and sweaty, almost like I was going to have a heart attack.

    ReplyDelete