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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer an intravenous (IV) loading dose of phenytoin to a 42-year-old client who recently experienced a tonic-clonic seizure. The client's vital signs are stable, but they remain postictal and drowsy. The client has a single peripheral IV catheter currently infusing 5% dextrose in water (D5W) at 75 mL/hr. Which of the following is the most appropriate nursing action?

  1. Pause the D5W infusion, flush the IV line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.Answer
  2. B
    Administer the phenytoin via a secondary IV piggyback line connected to the primary D5W infusion to ensure adequate dilution.
  3. C
    Calculate the prescribed dosage rate and inject the phenytoin slowly into the lowest Y-port of the continuous D5W infusion.
  4. D
    Withhold the medication and prioritize establishing a second peripheral IV line exclusively for the phenytoin administration.

Answer

The most appropriate action is to pause the D5W infusion, flush the IV line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.
Phenytoin is physically incompatible with all dextrose-containing solutions and will rapidly form a precipitate if mixed. To safely administer the medication through a single existing IV line that is infusing dextrose, the nurse must temporarily stop the primary infusion and thoroughly flush the line with a compatible solution (normal saline) both before and after the medication push. This prevents the drug from contacting the dextrose in the tubing.

Step-by-Step Solution

1
Identify the primary infusing fluid and verify compatibility with the prescribed medication.
The nurse notes D5W is infusing and recognizes that phenytoin is incompatible with dextrose.
Phenytoin precipitates when mixed with dextrose solutions, which can cause an embolism or occlude the IV line.
2
Determine the safest method to utilize the existing single IV access.
The nurse plans to use the SAS (Saline-Administer-Saline) method.
Since a second IV line is not present, the existing line can be used safely if the incompatible fluid is cleared from the tubing.
3
Execute the administration procedure safely.
Pause the D5W, flush with 0.9% sodium chloride, slowly push the phenytoin, flush again with 0.9% sodium chloride, and then resume the D5W.
This sequence ensures the medication never physically mixes with the dextrose within the catheter or tubing.

Key Concept

Pharmacological and Parenteral Therapies: IV Compatibility and Safe Medication Administration
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Topics

Pharmacological and Parenteral Therapies

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