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Difficulty: MediumPharmacological and Parenteral Therapies

Upon receiving a prescription for a loading dose of intravenous phenytoin, a nurse evaluates a client's vascular access. The client currently has a single peripheral catheter with 5% dextrose in water (D5W) infusing at 75 mL/hr. Which sequence of actions ensures safe delivery of the antiepileptic?

  1. A
    Attach the phenytoin as a secondary piggyback infusion to the port closest to the primary fluid bag.
  2. B
    Inject the medication directly into the lowest port of the actively infusing primary tubing over three to five minutes.
  3. Suspend the primary fluid, flush the catheter with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.Answer
  4. D
    Dilute the prescribed dose with sterile water and administer it through the primary line as a rapid bolus.

Answer

The nurse must suspend the primary dextrose fluid, flush the catheter with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.
Phenytoin is highly incompatible with dextrose-containing solutions and will form a solid precipitate if mixed. To administer the medication safely through a single line currently running a dextrose solution, the nurse must temporarily pause the continuous infusion, flush the line with 0.9% sodium chloride (normal saline) to clear any residual dextrose, administer the phenytoin, and then perform a final flush with normal saline before resuming the primary infusion.

Step-by-Step Solution

1
Analyze the prescribed medication and the current continuous infusion.
The nurse identifies that intravenous phenytoin is prescribed and 5% dextrose in water (D5W) is currently infusing through the only available vascular access.
Establishing baseline parameters is necessary to determine medication compatibility and safe administration routes.
2
Determine the compatibility of phenytoin with the primary infusion fluid.
The nurse recognizes that phenytoin is highly incompatible with all dextrose-containing solutions.
When mixed with dextrose, phenytoin quickly forms a solid micro-precipitate that can cause a life-threatening embolus.
3
Formulate a safe administration strategy using the existing single peripheral line.
The nurse plans to pause the D5W, flush the line thoroughly with 0.9% sodium chloride (normal saline), administer the drug at a safe rate, and flush again with normal saline before restarting the D5W.
This specific sequence completely separates the incompatible fluids, ensuring the medication safely reaches the client without crystallizing in the tubing.

Key Concept

Intravenous Compatibility and Safe Phenytoin Administration
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Topics

Pharmacological and Parenteral Therapies

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