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Difficulty: HardPharmacological and Parenteral Therapies

A critical care nurse is managing a mechanically ventilated client equipped with a triple-lumen central venous catheter. The three lumens are continuously delivering norepinephrine, total parenteral nutrition (TPN), and a lipid-based propofol emulsion. The client's cardiac monitor suddenly displays atrial fibrillation with a ventricular response of 152 beats per minute, and the provider orders an emergent intravenous bolus of diltiazem. After verifying that diltiazem is incompatible with both the vasopressor and the sedative, which action is the most appropriate for the nurse to take?

  1. A
    Halt the nutritional infusion temporarily, flush that specific lumen with sodium chloride, and push the medication
  2. B
    Suspend the sedative administration briefly to deliver the bolus, then immediately resume the infusion
  3. Initiate a new peripheral intravenous access site to administer the prescribed calcium channel blockerAnswer
  4. D
    Attach the medication syringe to the port closest to the client on the line delivering the vasopressor

Answer

Initiate a new peripheral intravenous access site to administer the prescribed calcium channel blocker.
When a client requires an emergent intravenous medication but all existing central venous catheter lumens are occupied by continuous infusions that cannot be safely interrupted or are incompatible, the nurse must establish a new peripheral intravenous access. Norepinephrine is a life-sustaining vasoactive drip that must never be paused or flushed, as flushing would deliver a dangerous bolus of the vasopressor. Total parenteral nutrition (TPN) requires a strictly dedicated line due to high risks of central line infection and drug incompatibility. Propofol is incompatible with the prescribed medication and provides necessary continuous sedation for mechanical ventilation. Therefore, securing a new peripheral line is the only safe method to administer the diltiazem bolus without compromising the client's hemodynamic or respiratory stability.

Step-by-Step Solution

1
Evaluate the existing continuous intravenous infusions.
Identified norepinephrine, TPN, and propofol infusing simultaneously in the three central lumens.
To determine if any current intravenous access lines can be safely utilized for an emergent intravenous push medication.
2
Analyze the compatibility and safety constraints of each continuous infusion.
Determined that norepinephrine cannot be flushed, TPN requires a strictly dedicated line, and propofol is incompatible with the ordered medication.
To prevent life-threatening adverse drug reactions, loss of airway sedation, or severe hemodynamic collapse.
3
Determine the safest route of administration for the emergent bolus.
Decided to start a new peripheral intravenous line.
When all central lines are occupied by incompatible or dedicated continuous infusions, establishing a new access site is required to safely administer the medication without compromising client stability.

Key Concept

Management of multiple continuous intravenous infusions and drug compatibility in critical care
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Topics

Pharmacological and Parenteral Therapies

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