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Difficulty: MediumPharmacological and Parenteral Therapies

An adult client with a history of epilepsy is admitted to the medical unit and has a continuous intravenous (IV) infusion of 5%5\% dextrose in water (D5W) infusing at 100 mL/hr100 \text{ mL/hr} through a peripheral catheter. The healthcare provider prescribes a 1,000 mg1,000 \text{ mg} loading dose of IV phenytoin to be administered promptly. The client has no other vascular access. Which action is most appropriate for the nurse to take?

  1. Pause the D5W infusion, flush the catheter with 0.9%0.9\% sodium chloride, administer the phenytoin, and flush the catheter again with 0.9%0.9\% sodium chloride.Answer
  2. B
    Connect the phenytoin as a secondary piggyback infusion directly into the primary D5W tubing.
  3. C
    Administer the phenytoin via slow IV push into the lowest port of the actively running D5W infusion.
  4. D
    Calculate the administration rate to deliver the 1,000 mg1,000 \text{ mg} dose over a 5-minute5\text{-minute} period using an electronic pump.

Answer

The nurse must pause the D5W infusion, flush the line with 0.9%0.9\% sodium chloride, administer the phenytoin, and flush the line again with 0.9%0.9\% sodium chloride.
The option describing flushing with 0.9%0.9\% sodium chloride before and after administration is correct because phenytoin is strictly incompatible with dextrose-containing solutions like D5W. Flushing clears the tubing of the incompatible fluid, allowing safe administration without precipitation.

Step-by-Step Solution

1
Identify the compatibility of the prescribed medication (phenytoin) with the current continuous infusion (5%5\% dextrose in water).
Phenytoin is recognized as incompatible with dextrose-containing solutions.
Administering incompatible medications can cause precipitation, which blocks the IV catheter or causes a potentially fatal embolus.
2
Determine the correct diluent and flush solution for phenytoin.
0.9%0.9\% sodium chloride (normal saline) is identified as the only compatible solution.
Normal saline maintains the stability of phenytoin in solution and prevents crystallization.
3
Plan the safe administration sequence for a single IV line.
The sequence must be: pause primary fluid, flush with normal saline, administer medication, flush with normal saline, and restart primary fluid.
This sequence ensures the incompatible medication and continuous fluid never mix in the IV tubing.

Key Concept

Phenytoin is incompatible with dextrose solutions and must be administered using 0.9%0.9\% sodium chloride to prevent precipitation.
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Topics

Pharmacological and Parenteral Therapies

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