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• W1998866964 abstract "To the Editor: The editorial comments made by Horowitz1.Horowitz Z. Fosphenytoin farewell?.Ann Emerg Med. 2004; 43: 398-400Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar in the March 2004 issue of Annals are cogent, particularly with regard to aggressive consideration of alternatives to intravenous administration of phenytoin. A niche consideration that is becoming increasingly more prevalent for the emergency physician is the presentation of a patient with a peripherally inserted central catheter. Use of the peripherally inserted central catheter when the patient needs intravenous phenytoin would appear reasonable; to our knowledge, there are no recommendations to the contrary. However, our Vascular Access Service strongly discourages use of the peripherally inserted central catheter for administration of intravenous phenytoin, and in fact, we routinely write orders on the inpatient service to prohibit this practice in all patients likely to receive this medication. The issue is one of clogging. We have found the frequency of occlusion of the peripherally inserted central catheter from intravenous phenytoin to be nearly universal and likely related to the small caliber and length of the lines. We have yet to unclog a catheter blocked with phenytoin debris despite attempts with wires and chemicals and instead must replace the line. Alternatively, we recommend use of fosphenytoin, either intravenously or intramuscularly, if the parenteral route of administration and phenytoin are still desired. Although we have not rigorously studied the utility of fosphenytoin in this scenario, we are aware that a request for fosphenytoin will initiate a series of discussions between the pharmacy and the ordering physician exploring cheaper alternatives. Inconvenience can be a great motivator, and in point of fact, we use very little fosphenytoin at our facility. We would support the poignancy of Horowitz's comments regarding the need to search actively for more optimal methods of seizure control when unable to administer phenytoin orally. Additionally, we would like to use this opportunity to call attention to the issue of peripherally inserted central catheter occlusion with the attendant risk of loss of vascular access as a significant consequence of the use of intravenous phenytoin. Fosphenytoin farewell?Annals of Emergency MedicineVol. 43Issue 3Preview Full-Text PDF" @default.
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• W1998866964 date "2004-10-01" @default.
• W1998866964 modified "2023-09-23" @default.
• W1998866964 title "Catheter occlusion from intravenous phenytoin" @default.
• W1998866964 doi "https://doi.org/10.1016/j.annemergmed.2004.04.018" @default.
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