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Difficulty: MediumPharmacological and Parenteral Therapies

A client with a systemic fungal infection is prescribed an intravenous infusion of amphotericin B. The client currently has a continuous intravenous infusion of 0.9% sodium chloride running through a single-lumen central venous catheter. Which of the following actions should the nurse take to safely administer the prescribed medication?

  1. Stop the primary infusion, flush the catheter with 5% dextrose in water, infuse the medication, and flush again with 5% dextrose in water.Answer
  2. B
    Connect the secondary tubing to the primary Y-site closest to the insertion site and infuse concurrently with the 0.9% sodium chloride.
  3. C
    Flush the catheter with 0.9% sodium chloride, infuse the medication, and flush again with 0.9% sodium chloride.
  4. D
    Set the infusion pump to deliver the entire dose of the medication over 30 minutes to minimize compatibility risks.

Answer

The nurse should stop the primary 0.9% sodium chloride infusion, flush the line with 5% dextrose in water (D5W), administer the amphotericin B, and then flush the line again with D5W.
Amphotericin B is highly incompatible with 0.9% sodium chloride and other electrolyte solutions. Mixing the two causes the medication to precipitate, which can lead to catheter occlusion or dangerous systemic emboli. To safely administer the drug through a line containing normal saline, the nurse must pause the primary infusion and flush the line with an inert, compatible solution like 5% dextrose in water (D5W) before and after the medication infusion.

Step-by-Step Solution

1
Identify the compatibility of the prescribed medication (amphotericin B) with the primary continuous intravenous fluid (0.9% sodium chloride).
Amphotericin B is incompatible with saline solutions and will precipitate if mixed.
Verifying intravenous fluid and medication compatibility is a critical safety check prior to administration to prevent patient harm and catheter occlusion.
2
Determine the appropriate flush solution and administration technique to safely deliver the medication through the existing single-lumen catheter.
The intravenous line must be cleared of the 0.9% sodium chloride using a compatible inert solution, which is 5% dextrose in water (D5W), before and after the medication is infused.
Using D5W creates a safe barrier between the incompatible saline solution and the amphotericin B.

Key Concept

Amphotericin B is incompatible with 0.9% sodium chloride (normal saline) and will precipitate; it must only be mixed and flushed with 5% dextrose in water (D5W).
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Topics

Pharmacological and Parenteral Therapies

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