A client who is experiencing continuous seizure activity requires an urgent intravenous (IV) dose of phenytoin. The client has a single peripheral IV access site that is currently infusing 5% dextrose in water (D5W). Which action should the nurse take to safely administer the prescribed medication?
- Stop the primary fluid, flush the line with 0.9% sodium chloride, administer the medication, and flush again with 0.9% sodium chloride.Answer
- BAttach the medication syringe directly to the lowest Y-site port and push it slowly while the primary fluids continue to infuse.
- CInstruct the unlicensed assistive personnel to quickly establish a new peripheral access site for the medication.
- DWait to administer the medication until the pharmacy delivers a compatible premixed bag of phenytoin and dextrose.
Answer
Stop the primary fluid, flush the line with 0.9% sodium chloride, administer the medication, and flush again with 0.9% sodium chloride.
Phenytoin is physically incompatible with all dextrose-containing solutions and will rapidly precipitate if they mix. Because the client has only one IV site and requires urgent medication to stop the seizures, the nurse must temporarily pause the D5W infusion, thoroughly flush the line with 0.9% sodium chloride (normal saline) to clear any residual dextrose, administer the phenytoin safely, and then flush again with normal saline before restarting the primary fluid.
Step-by-Step Solution
Key Concept
Phenytoin IV compatibility and safe parenteral administration
Estimated Time:45s