A nurse is preparing to administer an intravenous (IV) push medication through the lowest injection port of a primary IV line. The client has a single-lumen central venous catheter with a continuous infusion of a medication that is physically incompatible with the prescribed IV push drug. Arrange the following steps in the correct chronological order to safely administer this medication.
- 1Stop the continuous intravenous infusion pump.
- 2Clamp or pinch the primary IV tubing above the injection port closest to the client.
- 3Scrub the injection port hub, aspirate for a blood return, and flush the line with 10 mL of 0.9% sodium chloride.
- 4Administer the prescribed IV push medication over the recommended duration.
- 5Flush the line with 10 mL of 0.9% sodium chloride at the same rate the medication was administered.
- 6Unclamp the primary IV tubing and restart the continuous intravenous infusion.
Answer
The correct sequence is to first stop the pump, clamp the primary tubing, flush to clear the incompatible drug, administer the IV push medication slowly, flush again at the same slow rate to clear the line, and finally unclamp and restart the pump.
Safe administration of an IV push medication through a line with an incompatible continuous infusion requires complete isolation and clearing of the catheter. The pump must be stopped and the tubing clamped to prevent retrograde flow and mixing. The line is flushed before administration to clear the incompatible fluid, and flushed after administration at the same slow rate to prevent a rapid bolus of the medication residing in the catheter's dead space.
Step-by-Step Solution
Key Concept
When administering an IV push medication through a central line with an incompatible continuous infusion, the line must be clamped and thoroughly flushed before and after administration. Crucially, the post-flush must be delivered at the same slow rate as the medication to avoid bolusing the residual drug held in the catheter's dead space.