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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse in the emergency department is caring for a client who is experiencing continuous tonic-clonic seizures. The healthcare provider prescribes intravenous phenytoin. The client currently has an ongoing peripheral intravenous infusion of 5% dextrose in water (D5W). Which of the following is the most appropriate action by the nurse?

  1. Stop the D5W infusion, flush the intravenous line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.Answer
  2. B
    Connect the phenytoin to the Y-site port closest to the insertion site and administer it concurrently with the D5W infusion.
  3. C
    Position the client strictly supine with the head of the bed elevated to 90 degrees during the medication administration.
  4. D
    Withhold the medication temporarily and prioritize drawing an arterial blood gas sample to evaluate for respiratory acidosis.

Answer

The nurse must stop the D5W infusion, flush the line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.
Phenytoin is chemically incompatible with dextrose solutions and will form a precipitate if they mix. To safely administer intravenous phenytoin through an existing line that contains 5% dextrose in water (D5W), the nurse must first stop the D5W infusion, flush the intravenous line thoroughly with a compatible solution (0.9% sodium chloride), administer the phenytoin, and then flush the line again with 0.9% sodium chloride before resuming the dextrose infusion. This practice clears the tubing of incompatible fluids, ensuring safe medication delivery and preventing line occlusion or embolism.

Step-by-Step Solution

1
Identify the primary medical emergency.
The client is experiencing continuous tonic-clonic seizures (status epilepticus).
Immediate pharmacological intervention is required to halt seizure activity and prevent brain damage.
2
Assess the prescribed medication and current intravenous access.
Intravenous phenytoin is prescribed, but the client is receiving a continuous infusion of 5% dextrose in water (D5W).
Medication compatibility must be verified before administration.
3
Determine compatibility and safe administration technique.
Phenytoin is chemically incompatible with dextrose and forms a precipitate.
To prevent precipitation, the dextrose infusion must be stopped, and the line must be flushed with 0.9% sodium chloride (a compatible solution) before and after the phenytoin administration.

Key Concept

Intravenous Phenytoin Administration and Fluid Compatibility
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Topics

Pharmacological and Parenteral Therapies

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