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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a critically ill client who has a multi-lumen central venous catheter (CVC) in place. The client is receiving a continuous intravenous (IV) vasopressor infusion. Which of the following actions by the nurse demonstrate safe parenteral therapy and catheter management? (Select all that apply)

  1. Scrub the needleless connector hub with an appropriate antiseptic for at least 15 seconds before accessing.Answer
  2. Use a syringe with a barrel size of 10 mL or larger when flushing the catheter lumens.Answer
  3. Clamp any unused catheter lumens securely when they are not actively being used.Answer
  4. D
    Pause the continuous vasopressor infusion briefly to administer an incompatible IV push medication through the same lumen.
  5. E
    Delegate the sterile dressing change of the central venous catheter site to unlicensed assistive personnel (UAP).
  6. F
    Place the client in a high-Fowler's position immediately if a catheter-related air embolism is suspected.

Answer

The safe parenteral therapy practices are scrubbing the connector hub for at least 15 seconds, using a syringe with a 10 mL or larger barrel for flushing, and clamping unused lumens.
Safe central venous catheter management requires strict infection control (scrubbing the hub), preventing catheter damage (using at least a 10 mL syringe to avoid high pressure), and preventing air embolisms and blood reflux (clamping unused lumens).

Step-by-Step Solution

1
Evaluate the risk of infection.
Scrubbing the hub for 15 seconds is required to prevent CLABSI.
Central lines provide direct access to the central circulation, making infection prevention paramount.
2
Evaluate the physical maintenance of the catheter.
A 10 mL or larger syringe must be used for flushing, and unused lumens must be clamped.
Smaller syringes create high pressure that can rupture the line, and unclamped lumens risk air embolism or blood reflux.
3
Evaluate medication administration and delegation practices.
Incompatible medications cannot share a lumen, vasopressors must not be paused, UAPs cannot perform sterile dressing changes, and air embolisms require the left lateral Trendelenburg position.
These actions prevent hemodynamic instability, precipitation of medications, scope of practice violations, and catastrophic circulatory compromise.

Key Concept

Central Venous Catheter (CVC) Safe Management and Complication Prevention
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Topics

Pharmacological and Parenteral Therapies

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