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Difficulty: MediumPharmacological and Parenteral Therapies

An adult client is admitted with community-acquired pneumonia and has a continuous peripheral intravenous (IV) infusion of Lactated Ringer's solution running at 125 mL/hr125 \text{ mL/hr}. The healthcare provider prescribes a scheduled dose of intravenous ceftriaxone. Based on pharmacological safety principles, which action should the nurse perform?

  1. Stop the continuous infusion, flush the line thoroughly with 0.9%0.9\% sodium chloride, administer the antibiotic, and flush again before resuming.Answer
  2. B
    Connect the antibiotic as a secondary piggyback to infuse simultaneously through the Y-site of the primary IV line.
  3. C
    Administer the antibiotic via rapid intravenous push over 1 minute to minimize interruption of the primary fluid.
  4. D
    Withhold the antibiotic administration until the current bag of maintenance fluid has completely finished infusing.

Answer

The nurse should stop the primary infusion, flush the line with 0.9% sodium chloride, administer the ceftriaxone, and flush the line again before resuming the Lactated Ringer's.
Ceftriaxone is incompatible with calcium-containing solutions, such as Lactated Ringer's, because they can combine to form life-threatening precipitates. In adult clients, these two fluids cannot be administered simultaneously. However, they can be safely administered sequentially through the same intravenous line if the nurse pauses the primary fluid and thoroughly flushes the tubing with a compatible solution, such as 0.9% sodium chloride, both before and after the ceftriaxone infusion.

Step-by-Step Solution

1
Identify the active ingredients in the prescribed fluids.
The primary fluid is Lactated Ringer's (which contains calcium) and the prescribed medication is ceftriaxone.
Recognizing fluid components is the first step in assessing intravenous compatibility.
2
Determine the compatibility of ceftriaxone and calcium-containing solutions.
Ceftriaxone and calcium are incompatible and will form dangerous precipitates if mixed together.
Preventing the administration of incompatible intravenous medications is critical for client safety.
3
Select the appropriate administration technique for incompatible solutions through a single access site.
The primary infusion must be paused, and the tubing must be thoroughly flushed with a compatible fluid (like 0.9% sodium chloride) before and after the antibiotic.
Flushing clears the line of any residual calcium, allowing the safe sequential administration of the antibiotic.

Key Concept

Intravenous Compatibility and Safe Parenteral Administration
Estimated Time:1m 15s
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Topics

Pharmacological and Parenteral Therapies

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