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Difficulty: MediumPharmacological and Parenteral Therapies

A client with a history of recurrent seizures is admitted to the medical unit. The client has a single patent peripheral intravenous catheter with a continuous infusion of 5% dextrose in water (D5W) at 75 mL/hr. The healthcare provider prescribes an intermittent infusion of intravenous phenytoin. Which action is most appropriate for the nurse to take?

  1. Stop the continuous D5W infusion, flush the catheter with 0.9% sodium chloride, infuse the phenytoin, and flush again with 0.9% sodium chloride.Answer
  2. B
    Administer the phenytoin as a secondary piggyback infusion while the primary D5W solution continues to infuse.
  3. C
    Calculate the infusion rate to deliver the medication rapidly over 2 minutes to quickly achieve therapeutic serum levels.
  4. D
    Withhold the dose and contact the healthcare provider to request a change to oral administration due to the fluid incompatibility.

Answer

The correct action is to stop the continuous D5W infusion, flush the catheter with 0.9% sodium chloride, infuse the phenytoin, and flush again with 0.9% sodium chloride.
Phenytoin is highly incompatible with dextrose-containing solutions and will rapidly crystallize if they mix. Because the client only has one peripheral line, the safest approach is to stop the primary D5W infusion, flush the tubing with a compatible fluid (0.9% sodium chloride) to clear the dextrose, infuse the phenytoin, and then flush again with normal saline before resuming the D5W.

Step-by-Step Solution

1
Analyze the prescribed medication and the current continuous intravenous fluid.
The prescribed medication is phenytoin, and the running fluid is 5% dextrose in water (D5W).
Identifying the components is essential to check for drug-solution compatibility.
2
Determine the compatibility of phenytoin with D5W.
Phenytoin is highly incompatible with dextrose solutions and will form a precipitate.
Administering incompatible medications together can cause catheter occlusion and severe patient harm.
3
Select the appropriate nursing intervention for administering an incompatible medication through a single line.
The nurse must stop the primary infusion and flush the line with a compatible solution (0.9% sodium chloride) before and after administering the phenytoin.
This technique clears the tubing of the incompatible fluid, allowing safe administration without the need for a second intravenous access site.

Key Concept

Phenytoin Intravenous Compatibility and Safe Administration
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Topics

Pharmacological and Parenteral Therapies

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