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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer a scheduled dose of intravenous phenytoin to a client who has a seizure disorder and is currently NPO (nothing by mouth). The client has a single peripheral intravenous (IV) catheter with a continuous infusion of 5% dextrose in water (D5W) infusing at 75 mL/hr. Which action should the nurse take to safely administer the phenytoin?

  1. Pause the D5W infusion, flush the IV line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.Answer
  2. B
    Administer the phenytoin directly into the Y-site port closest to the client while the D5W continues to infuse.
  3. C
    Mix the prescribed dose of phenytoin in a 50 mL piggyback bag of D5W and administer it over 30 minutes.
  4. D
    Pause the D5W infusion, flush the IV line with sterile water, administer the phenytoin, and flush again with sterile water.

Answer

The nurse must pause the D5W infusion and flush the IV line with 0.9% sodium chloride both before and after administering the phenytoin.
Phenytoin is chemically incompatible with dextrose-containing solutions and will rapidly crystallize or precipitate if they come into contact. The only compatible IV fluid for phenytoin is 0.9% sodium chloride (normal saline). When a client has only one IV line infusing an incompatible fluid, the nurse must pause the primary infusion and flush the line thoroughly with normal saline both before and after administering the medication. This clears the tubing of dextrose, creates a safe barrier, and prevents precipitation.

Step-by-Step Solution

1
Identify the prescribed medication and the currently infusing intravenous fluid.
The medication is phenytoin, and the infusing fluid is 5% dextrose in water (D5W).
Verifying the current infusion is a critical safety step to determine chemical compatibility before giving any IV push medication.
2
Determine the chemical compatibility between the medication and the infusing fluid.
Phenytoin is highly incompatible with dextrose-containing solutions and will rapidly precipitate if they mix.
Administering incompatible medications can cause catheter occlusion, tissue damage, and potentially fatal emboli.
3
Select the appropriate intervention to safely administer the medication through the existing single IV line.
The nurse must pause the incompatible D5W, flush the line with a compatible solution (0.9% sodium chloride), administer the drug, and flush again with 0.9% sodium chloride before resuming the D5W.
The normal saline flush acts as a physical barrier in the IV tubing, ensuring the phenytoin never comes into contact with the dextrose.

Key Concept

Intravenous Medication Compatibility and Safety
Estimated Time:1m 15s
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Topics

Pharmacological and Parenteral Therapies

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