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Difficulty: HardPharmacological and Parenteral Therapies

A client experiencing continuous generalized tonic-clonic motor activity requires emergent administration of intravenous phenytoin. The client currently has a single 18-gauge peripheral venous catheter with a primary infusion of 5% dextrose in half-normal saline (D5 0.45% NaCl) running at 75 mL/hr. To ensure safe delivery of the anticonvulsant, which action must the nurse execute?

  1. Temporarily halt the primary fluid, irrigate the venous catheter with normal saline, inject the anticonvulsant, and irrigate again with normal saline.Answer
  2. B
    Attach the medication syringe to the distal port of the primary tubing and push the drug slowly while the primary solution continues to infuse.
  3. C
    Mix the prescribed dose into a 100 mL bag of 5% dextrose in water and infuse it as a secondary intermittent piggyback.
  4. D
    Delay the administration until a secondary peripheral venous access can be established to prevent drug precipitation in the primary line.

Answer

Temporarily halt the primary fluid, irrigate the venous catheter with normal saline, inject the anticonvulsant, and irrigate again with normal saline.
The correct action safely addresses the chemical incompatibility between phenytoin and the dextrose-containing primary fluid while prioritizing emergent treatment. By temporarily stopping the infusion and thoroughly flushing the line with normal saline before and after the phenytoin injection, the nurse prevents drug precipitation and ensures the rapid delivery of a life-saving anticonvulsant without the dangerous delay of starting a new IV.

Step-by-Step Solution

1
Analyze the client's clinical priority.
The client is in status epilepticus (continuous seizures), which is a medical emergency requiring immediate administration of an anticonvulsant to prevent brain damage.
Establishing the urgency dictates whether the nurse has time to start new IV lines or must use the existing access safely.
2
Evaluate the compatibility of the prescribed medication with the continuous infusion.
Phenytoin is highly incompatible with all dextrose-containing solutions, including the client's current D5 0.45% NaCl infusion.
Mixing phenytoin with dextrose causes the medication to precipitate, which can lead to emboli and loss of IV access.
3
Determine the safest and most efficient administration method.
The nurse must stop the incompatible primary fluid, flush the line thoroughly with 0.9% sodium chloride (normal saline), administer the phenytoin, and flush again with normal saline before restarting the primary fluid.
This 'flush-administer-flush' technique safely utilizes the existing IV line, prevents precipitation, and ensures the life-saving medication is delivered without delay.

Key Concept

Phenytoin must only be administered with 0.9% sodium chloride (normal saline) due to severe incompatibility and precipitation with dextrose solutions. In emergent situations, incompatible primary fluids must be stopped and the line flushed with normal saline before and after administration.
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Topics

Pharmacological and Parenteral Therapies

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