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Difficulty: HardPharmacological and Parenteral Therapies

A registered nurse is preparing to administer a prescribed dose of intravenous (IV) phenytoin to an adult client who recently experienced a generalized tonic-clonic seizure. The client has a single peripheral IV line with a continuous infusion of 5%5\% dextrose in water (D5W) infusing at 75 mL/hr75\text{ mL/hr}. Which of the following is the safest and most appropriate action by the nurse?

  1. Pause the continuous infusion and flush the IV line with 0.9%0.9\% sodium chloride before and after administering the phenytoin.Answer
  2. B
    Administer the medication as a rapid IV bolus over 1 minute1\text{ minute} to quickly achieve therapeutic serum levels.
  3. C
    Connect the phenytoin directly to the lowest Y-site port while the 5%5\% dextrose in water continues to infuse.
  4. D
    Monitor the client's continuous telemetry, specifically assessing for signs of hypertensive crisis and reflex tachycardia.

Answer

Pause the continuous infusion and flush the IV line with 0.9% sodium chloride before and after administering the phenytoin.
Phenytoin is highly incompatible with dextrose-containing solutions and will form a precipitate if mixed. Because the client has only one IV line, the nurse must pause the D5W infusion and thoroughly flush the line with 0.9%0.9\% sodium chloride (normal saline) both before and after administration. This maintains line patency, prevents crystal formation, and ensures safe delivery of the medication.

Step-by-Step Solution

1
Analyze the prescribed medication and the client's current IV fluids.
The medication to be administered is phenytoin, and the primary IV fluid is D5W.
Identifying potential drug-solution incompatibilities is a critical safety check before any IV medication administration.
2
Recall the compatibility guidelines and safe administration limits for intravenous phenytoin.
Phenytoin is incompatible with dextrose solutions and must be administered at a rate no faster than 50 mg/min.
Administering incompatible medications can cause crystallization in the tubing, and pushing the drug too fast causes cardiovascular collapse.
3
Determine the correct procedural steps for administration through a single IV line.
The nurse must pause the D5W, flush the line with 0.9% sodium chloride (normal saline), administer the phenytoin slowly, and flush again with normal saline before restarting the D5W.
Flushing clears the line of incompatible fluids and ensures the medication is safely and entirely delivered into the bloodstream without precipitating.

Key Concept

Phenytoin Intravenous Administration and Compatibility
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Topics

Pharmacological and Parenteral Therapies

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