A newly admitted adult client is recovering from a prolonged tonic-clonic seizure. The client has a peripheral venous catheter in the right forearm, which is currently infusing a maintenance solution of 5% dextrose in water at . The nurse must deliver a stat order of intravenous phenytoin. Which procedural approach ensures safe administration of this medication?
- Pause the primary infusion, flush the catheter thoroughly with normal saline, inject the phenytoin, and follow with another normal saline flush.Cevap
- BAttach the medication syringe to the lowest port on the primary tubing and push the medication while the dextrose solution continues to flow.
- CDilute the phenytoin directly into the primary maintenance bag of 5% dextrose to allow for a slow, continuous infusion over several hours.
- DDeliver the medication intravenously over 45 seconds to rapidly establish a therapeutic serum level and prevent recurrent seizure activity.
Cevap
The nurse must pause the dextrose infusion and thoroughly flush the intravenous line with normal saline both before and after administering the phenytoin.
Intravenous phenytoin is chemically incompatible with any solution containing dextrose. If mixed, the medication will immediately precipitate (crystallize). To safely administer this medication through a venous access device that is currently running a dextrose solution, the nurse must temporarily halt the primary infusion. The line must then be flushed aggressively with normal saline to clear out the dextrose. After slowly pushing the phenytoin, the nurse must flush the line a second time with normal saline before resuming the dextrose maintenance fluid. This 'flush-administer-flush' technique ensures the drug never comes into physical contact with the incompatible fluid.
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Anahtar Kavram
Intravenous Phenytoin Administration and Fluid Compatibility