A client presents to the emergency department in status epilepticus. The healthcare provider prescribes an immediate intravenous loading dose of phenytoin. The client has one established 20-gauge peripheral intravenous (IV) catheter, which is currently infusing a continuous solution of 5% dextrose in water (D5W) at 75 mL/hr. Which action outlines the safest and most appropriate method for the nurse to administer the prescribed medication?
- Pause the primary D5W infusion, flush the line with 0.9% sodium chloride, administer the medication at a rate not exceeding 50 mg/minute, and flush again with 0.9% sodium chloride.Answer
- BConnect the medication as a secondary piggyback directly into the Y-site of the primary D5W infusion tubing to ensure adequate dilution.
- CCalculate the infusion pump rate to deliver the total loading dose rapidly over a 5-minute period to quickly arrest the seizure activity.
- DWithhold the administration and advocate for immediate central venous catheter insertion, as administering this medication peripherally is contraindicated.
Answer
The correct action is to pause the incompatible dextrose solution, flush the line with normal saline, administer the phenytoin at a maximum rate of 50 mg/minute, and flush with normal saline again.
Phenytoin is highly alkaline and incompatible with solutions containing dextrose, which causes the drug to rapidly precipitate and form crystals. Therefore, the D5W infusion must be stopped, and the line must be flushed exclusively with 0.9% sodium chloride before and after administration. Furthermore, rapid intravenous administration of phenytoin is associated with severe cardiovascular collapse (hypotension and bradycardia); the infusion rate must never exceed 50 mg/minute in an adult client.
Step-by-Step Solution
Key Concept
Safe administration of intravenous phenytoin (Dilantin)