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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer a prescribed intravenous (IV) dose of phenytoin to a client. The client currently has a continuous IV infusion of 5% dextrose in water (D5W) running at 75 mL/hr through a peripheral IV catheter. Which action should the nurse take to administer the phenytoin safely?

  1. Stop the primary infusion and flush the IV line with 0.9% sodium chloride before and after medication administration.Answer
  2. B
    Administer the medication via slow IV push directly into the lowest Y-site port of the infusing D5W.
  3. C
    Mix the prescribed dose of phenytoin in a 50 mL bag of D5W and administer as a secondary piggyback.
  4. D
    Pause the D5W infusion, administer the phenytoin, and immediately restart the continuous infusion.

Answer

The nurse must stop the D5W infusion and flush the line with 0.9% sodium chloride before and after administering the phenytoin.
Phenytoin is highly incompatible with dextrose-containing solutions (such as D5W). If mixed, the phenytoin will rapidly crystallize and form a dangerous precipitate. To administer phenytoin safely through an existing D5W line, the nurse must stop the primary infusion and thoroughly flush the IV tubing with 0.9% sodium chloride (normal saline) both before and after giving the medication. This creates a safe barrier and prevents the incompatible solutions from ever mixing.

Step-by-Step Solution

1
Identify the medication to be administered and the current IV fluids.
The medication is phenytoin and the infusing fluid is D5W.
Establishing baseline parameters for safe medication administration.
2
Check drug-solution compatibility.
Phenytoin is heavily incompatible with D5W and will precipitate; it is only compatible with normal saline (0.9% sodium chloride).
Preventing severe adverse reactions such as embolization from crystallized medication in the bloodstream.
3
Determine the safest method to administer the medication through the existing line.
The line must be completely cleared of all dextrose before the phenytoin is introduced, and cleared of phenytoin before the dextrose is resumed.
Ensuring that the incompatible fluids never make contact inside the IV tubing.

Key Concept

Phenytoin Intravenous Compatibility
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Topics

Pharmacological and Parenteral Therapies

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