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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer an intermittent intravenous (IV) infusion of phenytoin to a client who has a single peripheral IV catheter. The client is currently receiving a continuous IV infusion of 5% dextrose in water (D5W). Which of the following is the most appropriate action by the nurse?

  1. A
    Attach the phenytoin administration set to the Y-site closest to the client while continuing the primary D5W infusion.
  2. B
    Ensure the phenytoin is diluted in a solution of 5% dextrose in 0.45% sodium chloride to maintain isotonicity.
  3. Stop the D5W infusion, flush the IV catheter with 0.9% sodium chloride, infuse the phenytoin, and flush again with 0.9% sodium chloride.Answer
  4. D
    Flush the IV catheter with sterile water, infuse the phenytoin, and flush again with sterile water to prevent precipitation.

Answer

The most appropriate action is to stop the D5W infusion, flush the IV catheter with 0.9% sodium chloride, infuse the phenytoin, and flush again with 0.9% sodium chloride.
The correct action ensures the safe administration of phenytoin by preventing it from mixing with dextrose. Phenytoin is physically incompatible with all dextrose-containing solutions and will form a solid precipitate if mixed. Because the client has only one IV access site, the nurse must temporarily stop the primary infusion, flush the line thoroughly with 0.9% sodium chloride (normal saline) to clear the dextrose, administer the phenytoin, and flush again with normal saline before resuming the primary infusion.

Step-by-Step Solution

1
Analyze the physical compatibility between the prescribed medication (phenytoin) and the continuous IV fluid (D5W).
Phenytoin is strictly incompatible with any solution containing dextrose.
Mixing phenytoin with dextrose causes immediate crystallization and precipitation, creating a severe risk for an embolism.
2
Determine the required compatible diluent and flush solution for phenytoin administration.
0.9% sodium chloride (normal saline) is the only compatible fluid for mixing and flushing phenytoin.
Normal saline maintains the chemical stability of the phenytoin solution and prevents the formation of solid particles.
3
Formulate a safe administration sequence using the client's single peripheral IV site.
The primary D5W infusion must be paused, and the IV line must be flushed with normal saline both before and after the phenytoin is infused.
This sequence completely isolates the phenytoin from the dextrose within the IV tubing, ensuring safe drug delivery without requiring an additional venipuncture.

Key Concept

Intravenous (IV) medication compatibility and safe administration of phenytoin
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Topics

Pharmacological and Parenteral Therapies

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