A client with a seizure disorder has a continuous intravenous (IV) infusion of 5% dextrose in water (D5W) running through a peripheral catheter. The nurse needs to administer a scheduled dose of IV phenytoin. What is the most appropriate technique for the nurse to administer this medication through the existing access?
- AAttach the phenytoin syringe to the port closest to the client and administer it slowly while the D5W continues to infuse
- BDilute the phenytoin dose in a 50 mL bag of 5% dextrose in water and administer it as a secondary piggyback infusion
- Stop the primary infusion, flush the tubing with 0.9% sodium chloride, inject the phenytoin, and flush again with 0.9% sodium chlorideAnswer
- DPause the primary infusion, inject the phenytoin directly into the IV access port, and immediately resume the D5W
Answer
The nurse must stop the primary D5W infusion, flush the line with 0.9% sodium chloride, administer the phenytoin, and then flush the line again with 0.9% sodium chloride.
Phenytoin is notorious for its strict incompatibility with dextrose-containing solutions. When mixed with D5W, it rapidly crystallizes and forms a solid precipitate. To safely administer phenytoin through an existing line that contains dextrose, the nurse must stop the primary infusion and flush the tubing with 0.9% sodium chloride (normal saline) before the medication is given. After the phenytoin is administered, the line must be flushed again with normal saline to ensure the entire dose has cleared the catheter before the dextrose infusion is resumed. This ensures no mixing of the incompatible substances occurs.
Step-by-Step Solution
Key Concept
Phenytoin IV Compatibility and Administration Sequence