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Difficulty: HardPharmacological and Parenteral Therapies

A client recovering from a cluster of generalized tonic-clonic seizures has a single 20-gauge peripheral intravenous (IV) catheter in the right forearm. A continuous maintenance infusion of 5% dextrose in 0.45% sodium chloride is currently infusing at 100 mL/hr. The healthcare provider prescribes a loading dose of IV phenytoin to be administered immediately to prevent further seizure activity. Which action is the most appropriate for the nurse to implement?

  1. Stop the primary infusion, flush the catheter with 0.9% sodium chloride, administer the medication slowly, and flush again with 0.9% sodium chloride.Answer
  2. B
    Administer the medication through the Y-site port closest to the client while allowing the primary fluid to infuse concurrently.
  3. C
    Dilute the prescribed dose in a 50 mL bag of 5% dextrose in water and infuse it as an intermittent secondary piggyback.
  4. D
    Administer the undiluted medication via rapid IV push over 1 to 2 minutes to rapidly achieve therapeutic serum levels.

Answer

The nurse must stop the primary dextrose infusion, flush the IV line with 0.9% sodium chloride (normal saline), administer the phenytoin slowly, and flush again with normal saline before restarting the maintenance fluids.
Phenytoin is highly incompatible with any solution containing dextrose. When mixed, it forms a solid precipitate that can occlude the IV catheter or cause a fatal embolism if it enters the bloodstream. Because the client only has one IV line and the medication is urgently needed, the safest approach is to temporarily stop the dextrose infusion, flush the line thoroughly with 0.9% sodium chloride (normal saline), administer the phenytoin safely (not exceeding 50 mg/min), and flush the line again with normal saline before restarting the primary maintenance fluid.

Step-by-Step Solution

1
Analyze the prescribed medication and the current IV fluids.
The prescribed medication is phenytoin. The current infusing fluid contains 5% dextrose.
Identifying the components of parenteral therapies is the first step in determining IV compatibility.
2
Recall the pharmacological properties and safety parameters of intravenous phenytoin.
Phenytoin is highly alkaline and precipitates instantly when mixed with dextrose solutions. Furthermore, it carries a strict cardiovascular safety limit (maximum administration rate of 50 mg/min).
Understanding drug-specific risks prevents life-threatening complications such as medication embolism or cardiac arrest.
3
Determine the safest method to administer the medication through the existing single peripheral line.
The nurse must pause the incompatible fluid, clear the line with a compatible flush (0.9% sodium chloride), administer the drug at a safe rate, and clear the line again before resuming the primary fluid.
This sequence ensures the phenytoin reaches the systemic circulation without crystallizing in the tubing and without requiring a delay to place a second IV line.

Key Concept

Intravenous Phenytoin Administration Safety and Compatibility
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Topics

Pharmacological and Parenteral Therapies

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