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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a client diagnosed with cardiogenic shock who is receiving a continuous intravenous (IV) infusion of dobutamine through a single-lumen peripheral IV catheter. The healthcare provider prescribes a one-time dose of IV push furosemide to be administered immediately for acute pulmonary edema. Upon checking the institutional compatibility guide, the nurse confirms that dobutamine and furosemide are physically incompatible at the Y-site. Which of the following is the most appropriate action by the nurse?

  1. Insert a second peripheral IV catheter to administer the furosemide.Answer
  2. B
    Pause the dobutamine infusion, flush the IV line with normal saline, administer the furosemide, and restart the dobutamine.
  3. C
    Administer the furosemide via the IV port furthest from the client to allow dilution before the medications mix.
  4. D
    Contact the pharmacy to request a different concentration of furosemide that is compatible with dobutamine.

Answer

Insert a second peripheral IV catheter to administer the furosemide.
Dobutamine is a critical, life-sustaining positive inotrope used to maintain cardiac output in cardiogenic shock. Pausing the infusion, even briefly, can precipitate a rapid and life-threatening hemodynamic collapse. Because the medications are physically incompatible and cannot be mixed in the same tubing, the standard 'flush-push-flush' technique cannot be used. Therefore, the only safe and prompt action is to establish a second peripheral IV access to administer the furosemide.

Step-by-Step Solution

1
Evaluate the client's hemodynamic stability and the purpose of the current continuous infusion.
The client is in cardiogenic shock and dobutamine is a life-sustaining vasoactive medication that maintains cardiac output.
To determine if the continuous infusion can be safely interrupted.
2
Analyze the compatibility of the prescribed medications.
Furosemide and dobutamine are incompatible at the Y-site.
Administering incompatible medications together can cause crystallization and precipitation in the IV line.
3
Determine the safest method to administer the stat medication.
Because the primary infusion cannot be paused and the drugs cannot be mixed, a secondary IV access point must be established.
To ensure both the continuous support of the dobutamine and the prompt administration of the furosemide.

Key Concept

Safe Administration of Incompatible Intravenous Medications in Critically Ill Clients
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Topics

Pharmacological and Parenteral Therapies

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