OBJECTIVE

To establish guidelines for the safe administration of intravenous loading doses of Phenytoin.

 

SCOPE

Registered Nurses, Licensed Practical Nurses, Pharmacists, Physicians, Physician Assistants

 

POLICY

To safely administer by reducing the potential side effects and toxicities associated with intravenous administration of Phenytoin, the following guidelines should be utilized for all patients receiving intravenous loading doses of Phenytoin.

 

PROVISIONS

 

  1. Administer oral Phenytoin whenever possible or tolerable by patient as per physician order.

 

  1. Intravenous loading doses of Phenytoin are weight based:

 

(Concentration Desired – Concentration Actual) x 0.7 x weight in kg = dose in mg

0.92

or

15-20mg/kg = dose in mg

 

  1. Patients on non monitored units should receive intravenous loading doses of Phenytoin at a rate of 20mg/minute in 3 divided doses at 2 hour intervals (see attached nomogram)

 

  1. If a patient’s condition warrants the patient receiving intravenous loading doses of Phenytoin at a rate of 50mg/minute on a non monitored unit, the patient must be placed on a cardiac monitor and a licensed Physician, resident, or ACLS certified PA must be in attendance throughout the entire infusion of the medication.

 

  1. Intravenous Phenytoin must be given via an infusion pump.  The intravenous line must be filtered using a 0.22 micron filter.

 

  1. Phenytoin is not compatible with dextrose.   Flush the intravenous line with NS before and after administration.

 

  1. The patient receiving a loading dose of intravenous Phenytoin is to be monitored: vital signs, CNS and IV site within one hour prior to administration, 5 minutes after starting, 15 minutes after starting and then at end of infusion.  If hypotension or bradycardia occur, decrease infusion rate by 50%, notify physician, and monitor patient every 5 minutes X 3 and/or until stable.

 

ATTACHMENT

IV Phenytoin Nomogram.

 

ADMINISTRATIVE RESPONSIBILITY

The Clinical Manager has the operational responsibility for the enforcement of this policy.

 

APPROVAL SIGNATURE(S)

 

 

                                                                                                                                                           

V.P. Patient Care Services                                                                                                         Date

                                                           

 

REVIEW DATE:  08/15/2006

 

 

SUPERSEDES:  None