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Zorluk: ZorPharmacological and Parenteral Therapies

An adult client admitted with a traumatic brain injury begins to exhibit sustained tonic-clonic seizure activity. The client has one dedicated peripheral intravenous (IV) catheter currently infusing 5% dextrose in 0.45% sodium chloride at 100 mL/hr. The physician orders a 1,000 mg loading dose of intravenous phenytoin. Which of the following actions demonstrates the safest administration technique for this medication?

  1. Pause the primary infusion, flush the line with 0.9% sodium chloride, administer the medication through an inline filter, and flush again with 0.9% sodium chloride.Cevap
  2. B
    Attach the phenytoin to the lowest Y-site port of the primary tubing to allow simultaneous administration with the maintenance fluids.
  3. C
    Dilute the ordered dose in a 100 mL bag of 5% dextrose in water and administer it as a secondary infusion over 30 minutes.
  4. D
    Administer the undiluted medication as a rapid intravenous push over 2 to 3 minutes to quickly achieve therapeutic serum drug levels.

Cevap

Pause the primary infusion, flush the line with 0.9% sodium chloride, administer the medication through an inline filter, and flush again with 0.9% sodium chloride.
Phenytoin is highly alkaline and physically incompatible with all dextrose-containing solutions, which cause it to rapidly precipitate. Therefore, the primary dextrose infusion must be paused, and the intravenous line must be flushed thoroughly with 0.9% sodium chloride (normal saline) both before and after administration to clear the line of any dextrose. Additionally, intravenous phenytoin requires an inline filter to catch any microscopic crystals and must be administered slowly (not exceeding 50 mg/min) to prevent severe hypotension and cardiac arrhythmias.

Adım Adım Çözüm

1
Identify the continuous maintenance fluid currently infusing.
The client is receiving a solution containing dextrose (5% dextrose in 0.45% sodium chloride).
Determining compatibility with the prescribed IV push medication is the first principle of safe parenteral administration.
2
Evaluate the specific pharmacological properties and compatibility requirements of intravenous phenytoin.
Phenytoin is physically incompatible with any dextrose-containing solutions and requires an inline filter for administration.
Mixing phenytoin with dextrose causes rapid precipitation and crystal formation, which can lead to a potentially fatal embolism or line occlusion.
3
Determine the safe rate of administration.
The maximum safe administration rate for IV phenytoin in adults is 50 mg/min. A 1,000 mg dose must be infused over a minimum of 20 minutes.
Rapid infusion of phenytoin is severely cardiotoxic and can cause profound hypotension, bradycardia, and arrhythmias.
4
Select the safest administration technique based on these physiological constraints.
The primary dextrose infusion must be paused, the line flushed extensively with 0.9% sodium chloride, the medication infused through a filter, and the line flushed again before resuming maintenance fluids.
This sequence completely prevents mixing incompatible solutions while adhering to all safety requirements for this high-alert medication.

Anahtar Kavram

Safe Intravenous Administration of Phenytoin
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Konular

Pharmacological and Parenteral Therapies

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