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Difficulty: MediumPharmacological and Parenteral Therapies

A critical care nurse is caring for a client with septic shock who has a multi-lumen central venous catheter. The client is receiving a continuous intravenous infusion of norepinephrine and is now prescribed an intermittent intravenous infusion of vancomycin. Which of the following nursing actions ensure safe pharmacological and parenteral therapy administration? (Select all that apply.)

  1. Designate a dedicated lumen of the central venous catheter exclusively for the continuous norepinephrine infusion.Answer
  2. Administer the continuous norepinephrine infusion using an electronic infusion pump with dose error reduction software.Answer
  3. Flush an available secondary lumen with sterile normal saline before and after administering the intermittent vancomycin dose.Answer
  4. D
    Pause the continuous norepinephrine infusion temporarily while the vancomycin infuses to prevent chemical precipitation.
  5. E
    Program the electronic infusion pump to deliver the vancomycin dose over 15 minutes to rapidly achieve therapeutic serum levels.
  6. F
    Connect the vancomycin as a secondary piggyback directly into the continuous norepinephrine infusion line.

Answer

The correct actions are to designate a dedicated lumen for the norepinephrine, use an electronic infusion pump for the pressor, and flush a secondary lumen with normal saline before and after the vancomycin dose.
Safe parenteral administration of high-alert medications requires strict adherence to safety protocols. Norepinephrine is a potent vasopressor used to sustain blood pressure in septic shock; it must be administered via a dedicated central line lumen using an electronic infusion pump to ensure precise, uninterrupted delivery. Vancomycin is an intermittent antibiotic that should be administered through a separate, properly flushed lumen to maintain patency and avoid incompatibilities.

Step-by-Step Solution

1
Analyze the client's condition and the prescribed therapies.
The client has septic shock (hemodynamically unstable) and is receiving norepinephrine (a high-alert continuous vasopressor) and vancomycin (an intermittent antibiotic requiring specific rate controls).
Identifying the critical nature of the client and the specific requirements of each medication is the first step in safe parenteral administration.
2
Determine the requirements for safe norepinephrine administration.
Norepinephrine requires a dedicated central line lumen, an electronic infusion pump, and must never be paused or mixed with other medications.
Even minor fluctuations in a vasopressor infusion rate can cause severe cardiovascular instability.
3
Determine the requirements for safe vancomycin administration.
Vancomycin must be infused slowly over at least 60 minutes via an available separate lumen, with normal saline flushes before and after.
Rapid vancomycin infusion causes Red Man Syndrome, and using a separate flushed lumen prevents drug incompatibilities.

Key Concept

Safe administration of high-alert continuous vasopressors and intermittent intravenous antibiotics.
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Topics

Pharmacological and Parenteral Therapies

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