Name of the Procedure:

Phenytoin; total - also known as Dilantin level test

Summary

A Phenytoin; total test measures the amount of the drug phenytoin in the blood to ensure the medication level is within the therapeutic range for treating epilepsy and preventing seizures.

Purpose

The procedure monitors phenytoin levels in patients being treated for epilepsy or other seizure disorders to ensure the dosage is effective and safe. It helps to tailor medication dosages for optimal patient care and to avoid toxicity.

Indications

• Seizure disorders (e.g., epilepsy)
• Monitoring therapeutic levels of phenytoin
• Adjusting phenytoin dosage
• Evaluating potential phenytoin toxicity
• Symptoms suggesting phenytoin imbalance, such as dizziness or uncoordinated movements

Preparation

• Patients may need to inform their doctor about all medications they are taking.
• Fasting is not typically required.
• Timing of the blood draw may be important, often scheduled just before the next dose of phenytoin.

Procedure Description

1. A healthcare professional will clean the area on the patient’s arm with an antiseptic.
2. A tourniquet is tied around the upper arm to fill veins with blood.
3. A needle is then inserted into a vein to draw blood into a vial or syringe.
4. The tourniquet is removed, and once enough blood is collected, the needle is withdrawn.
5. The puncture site is covered with a sterile bandage.
6. The blood sample is sent to a lab for analysis using a specialized assay to measure phenytoin levels.

Duration

The blood draw takes approximately 5-10 minutes.

Setting

The procedure is performed in a hospital, outpatient clinic, or a laboratory setting.

Personnel

• Licensed phlebotomist or nurse
• Laboratory technician or medical technologist who analyzes the blood sample

Risks and Complications

• Minor bruising or bleeding at the puncture site
• Infection at the puncture site (rare)
• Fainting or dizziness
• Hematoma formation

Benefits

• Ensures phenytoin levels are within the therapeutic range
• Helps to prevent seizures
• Avoids potential side effects and toxicity from incorrect dosages
• Aids in the proper adjustment of medication dosage

Recovery

• Immediate post-procedure care involves applying pressure to the puncture site to stop any bleeding.
• Patients can resume normal activities immediately after.
• Follow-up with the prescribing physician may be necessary to adjust phenytoin dosage based on results.

Alternatives

• Other antiepileptic drug level tests, depending on the specific medication prescribed.
• Alternative seizure monitoring methods, such as EEG (Electroencephalogram).

Pros and Cons of Alternatives:

• Other drug level tests: Appropriate for monitoring other medications but not specific for phenytoin.
• EEG: Provides real-time information on brain activity but does not measure drug levels.

Patient Experience

• During: Mild discomfort or a brief sharp sensation when the needle is inserted.
• After: Minimal to no pain post-procedure; normal activities can be resumed immediately.
• Comfort measures: Ice pack if bruising occurs, over-the-counter pain medication if needed.