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Difficulty: HardPharmacological and Parenteral Therapies

The nurse is caring for a client who was recently admitted with a massive pulmonary embolism. The client is currently receiving a continuous intravenous infusion of unfractionated heparin through a single-lumen peripheral catheter. A new prescription is received for an urgent dose of intravenous vancomycin to treat a suspected bloodstream infection. After consulting a drug reference and discovering that the two medications are physically incompatible, which action should the nurse take?

  1. A
    Attach the vancomycin secondary tubing to the primary tubing Y-site closest to the client.
  2. Insert a second peripheral intravenous catheter to administer the vancomycin.Answer
  3. C
    Pause the heparin infusion, flush the line with normal saline, administer the vancomycin, and resume the heparin.
  4. D
    Instruct the unlicensed assistive personnel (UAP) to monitor the client for adverse reactions while the vancomycin infuses.

Answer

Insert a second peripheral intravenous catheter to administer the vancomycin.
Heparin is a high-alert medication with a short half-life (11 to 2 hours2\text{ hours}). Pausing this critical continuous infusion for the 6060 to 90 minutes90\text{ minutes} required to administer intravenous vancomycin would cause the client's anticoagulation levels to drop subtherapeutically, risking life-threatening clot extension. Because the medications are physically incompatible and cannot be mixed, the safest and most appropriate action is to establish a second peripheral intravenous line. This ensures the client receives the urgent antibiotic without interrupting the essential anticoagulation therapy.

Step-by-Step Solution

1
Identify the continuous infusion and its clinical purpose.
The client is receiving heparin for a massive pulmonary embolism.
Heparin has a short half-life and is critical for preventing life-threatening clot expansion in this unstable client.
2
Analyze the medication compatibility.
Heparin and vancomycin are physically incompatible.
Incompatible medications cannot be administered through the same intravenous line simultaneously due to the risk of precipitation.
3
Evaluate alternative administration methods.
Pausing the heparin for a vancomycin infusion (which typically takes 6060 to 90 minutes90\text{ minutes}) is unsafe.
Prolonged interruption of heparin therapy in a client with a massive pulmonary embolism compromises circulation and violates prioritization principles.
4
Determine the safest nursing intervention.
A second peripheral intravenous line must be established.
This allows both critical therapies to run continuously and safely without mixing or dangerous interruptions.

Key Concept

Management of physically incompatible intravenous medications during critical continuous infusions
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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