During a shift assessment, the nurse receives a new prescription for 300 mg of phenytoin via intravenous (IV) push for a client with seizure activity. The client has a single peripheral IV access site currently infusing a continuous solution of 5% dextrose in 0.45% sodium chloride at 100 mL/hr. Which method of administration demonstrates the safest practice by the nurse?
- Pausing the continuous IV fluid, flushing the access with 0.9% sodium chloride, administering the medication slowly over at least 6 minutes, and flushing again with 0.9% sodium chloride.Answer
- BAttaching the syringe to the Y-site port closest to the client and pushing the medication simultaneously while the continuous dextrose solution is infusing.
- CDiluting the phenytoin dose in a 50 mL bag of 5% dextrose in water (D5W) and infusing it as a secondary piggyback over 30 minutes.
- DPausing the continuous infusion, pushing the undiluted medication rapidly over 1 to 2 minutes to quickly achieve therapeutic levels, and then restarting the fluid.
Answer
The safest practice is to pause the incompatible dextrose infusion, flush the line thoroughly with normal saline (0.9% sodium chloride), administer the phenytoin over at least 6 minutes, and flush again with normal saline before restarting the continuous fluid.
Phenytoin is highly incompatible with all dextrose-containing solutions and will precipitate (crystallize) in the IV tubing if mixed. Therefore, the continuous dextrose infusion must be paused, and the line must be flushed with a compatible solution (0.9% sodium chloride) both before and after administration. Additionally, phenytoin carries a high risk for cardiovascular collapse if pushed too quickly; its administration rate must never exceed 50 mg per minute. A 300 mg dose requires a minimum administration time of 6 minutes to ensure patient safety.
Step-by-Step Solution
Key Concept
Phenytoin IV administration safety principles: managing dextrose incompatibility and adhering to strict maximum infusion rates.