Examkin

Question

Difficulty: HardPharmacological and Parenteral Therapies

A client diagnosed with a massive pulmonary embolism is receiving a continuous intravenous (IV) infusion of unfractionated heparin. The healthcare provider prescribes an intermittent IV antibiotic to be infused over 90 minutes. Upon checking the facility's drug reference guide, the nurse notes that the antibiotic is chemically incompatible with heparin. The client currently has only one patent 20-gauge peripheral IV catheter. Which action is most appropriate for the nurse to take?

  1. Establish a second peripheral IV access to administer the intermittent antibiotic infusion.Answer
  2. B
    Pause the heparin infusion, flush the IV catheter with 0.9% sodium chloride, infuse the antibiotic over 90 minutes, and flush again before resuming.
  3. C
    Connect the antibiotic tubing to the lowest Y-site port on the primary heparin tubing to minimize the time the drugs are mixed.
  4. D
    Calculate the necessary rate to administer the antibiotic as a rapid IV push over 5 minutes to minimize the interruption of the heparin infusion.

Answer

The most appropriate action is to establish a second peripheral IV access to administer the intermittent antibiotic infusion.
The client requires a continuous infusion of heparin for a massive pulmonary embolism. Heparin has a short half-life, and pausing the infusion for 90 minutes to administer an incompatible antibiotic will cause subtherapeutic activated partial thromboplastin time (aPTT) levels, risking life-threatening thrombus extension. Establishing a second peripheral IV access is the only safe action that allows both the critical continuous infusion and the necessary antibiotic to be administered concurrently without chemical precipitation or therapeutic interruption.

Step-by-Step Solution

1
Analyze the client's current therapies.
The client is on a continuous heparin infusion for a critical condition (pulmonary embolism) and requires a 90-minute intermittent antibiotic.
To understand the clinical priority and pharmacokinetics of the prescribed treatments.
2
Evaluate the compatibility of the prescribed medications.
The antibiotic and heparin are chemically incompatible.
To determine if they can be safely co-administered in the same IV line.
3
Determine the physiological impact of pausing the continuous infusion.
Pausing heparin for 90 minutes is unsafe due to its short half-life and the high risk of clot extension.
To rule out the standard 'flush, infuse, flush' technique, which is only safe for short 2-5 minute IV pushes.
4
Identify the safest alternative administration method.
Starting a second peripheral IV line allows both necessary therapies to run simultaneously without physical interaction.
To maintain therapeutic anticoagulant levels while properly treating the infection.

Key Concept

Management of Intravenous Incompatibilities with Critical Continuous Infusions
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic