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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is caring for a client in septic shock who is receiving a continuous intravenous (IV) infusion of norepinephrine through a dedicated single-lumen peripherally inserted central catheter (PICC). The client's current blood pressure is 86/48 mmHg. The healthcare provider prescribes pantoprazole 40 mg IV push daily. Which action should the nurse take first?

  1. A
    Administer the pantoprazole directly into the lowest Y-site of the continuous norepinephrine infusion.
  2. Establish a new peripheral intravenous access for the pantoprazole administration.Answer
  3. C
    Pause the norepinephrine infusion for two minutes to administer the pantoprazole, then immediately restart.
  4. D
    Calculate a rapid administration rate of 15 seconds to minimize the interruption of the norepinephrine infusion.

Answer

Establish a new peripheral intravenous access for the pantoprazole administration.
Norepinephrine is a critical, life-sustaining vasoactive medication with a very short half-life. Pausing the infusion even briefly can result in a precipitous and potentially fatal drop in blood pressure. Furthermore, administering an IV push medication through a line actively infusing a vasopressor can 'flush' a rapid bolus of the vasopressor into the client, causing a severe hypertensive crisis. Therefore, the only safe priority action is to establish a completely separate IV access for the pantoprazole.

Step-by-Step Solution

1
Analyze the client's current hemodynamic status and current continuous infusions.
The client is in septic shock with a dangerously low blood pressure (86/48 mmHg) dependent on a continuous norepinephrine infusion.
Norepinephrine has a very short half-life and must be infused continuously without interruption to maintain perfusion.
2
Evaluate the prescribed medication and route.
Pantoprazole 40 mg is prescribed via IV push, which typically requires administration over at least 2 minutes.
Safe medication administration requires knowing the correct rate and ensuring the route will not compromise other treatments.
3
Assess the compatibility and safety of using the existing IV line.
The existing line is a single-lumen PICC dedicated to a vasopressor. Pushing a medication into this line or pausing the pump is contraindicated.
Pushing medication into a vasopressor line can flush a large bolus of the vasopressor into the client (causing hypertensive crisis), and pausing the pump will cause a precipitous drop in blood pressure.
4
Determine the safest alternative intervention.
The nurse must start a separate peripheral IV line to administer the pantoprazole safely.
Establishing a second IV access allows the routine medication to be given without interrupting or altering the delivery of the life-sustaining vasopressor.

Key Concept

Safe administration of IV push medications with concurrent vasoactive infusions
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Topics

Pharmacological and Parenteral Therapies

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