A nurse is preparing to administer a scheduled dose of intravenous phenytoin to a client with a seizure disorder. The client has a single peripheral intravenous line with a continuous infusion of 5% dextrose in water (D5W) infusing at 75 mL/hr. Based on the safe administration guidelines for this medication, which action should the nurse take?
- Pause the continuous infusion, flush the intravenous line thoroughly with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride before restarting the infusion.Answer
- BConnect the syringe directly to the Y-port closest to the client and administer the medication slowly while the primary fluid continues to infuse.
- CAdminister the intravenous push medication at a rapid rate of 100 mg per minute to ensure immediate therapeutic suppression of seizure activity.
- DWithhold the scheduled phenytoin dose until the continuous D5W infusion is entirely completed to ensure the intravenous line is completely clear.
Answer
Pause the continuous infusion, flush the intravenous line thoroughly with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride before restarting the infusion.
The correct action ensures patient safety by preventing a dangerous chemical incompatibility. Phenytoin is incompatible with dextrose solutions (D5W) and will precipitate, creating solid particles in the IV line that can lead to an embolism. To safely use the same IV site, the nurse must pause the incompatible fluid, flush the line with a compatible fluid (0.9% sodium chloride), administer the medication, and flush again to clear the tubing before resuming the D5W.
Step-by-Step Solution
Key Concept
Intravenous Compatibility and Safe Administration of Phenytoin