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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is caring for a client with acute decompensated heart failure. The client is receiving a continuous intravenous (IV) infusion of milrinone through a single-lumen peripherally inserted central catheter (PICC). The healthcare provider prescribes an immediate, one-time IV bolus of furosemide. Which action by the nurse is the safest method to administer the furosemide?

  1. Start a separate peripheral IV line to administer the furosemide bolusAnswer
  2. B
    Pause the milrinone infusion, flush the PICC with normal saline, administer the furosemide, and flush again
  3. C
    Attach the furosemide syringe to the lowest Y-site on the milrinone tubing and push slowly over two minutes
  4. D
    Temporarily decrease the milrinone infusion to a keep-vein-open rate while pushing the furosemide through the proximal port

Answer

The safest method is to establish a new, separate peripheral IV line to administer the furosemide.
Establishing a separate peripheral IV line is the only safe action. Milrinone and furosemide are highly incompatible and will immediately precipitate if they come into contact. Furthermore, because the client has a single-lumen PICC, the standard practice of pausing the infusion and flushing the line with saline is contraindicated. The catheter's dead space contains a high concentration of milrinone; flushing it would inadvertently deliver a rapid, concentrated bolus of the inotrope directly into the central circulation, which can trigger profound hypotension and lethal arrhythmias.

Step-by-Step Solution

1
Identify the chemical compatibility between the continuous infusion and the prescribed stat medication.
Milrinone and furosemide are physically incompatible and will form a precipitate if mixed.
Mixing incompatible medications can lead to crystallization and life-threatening emboli.
2
Assess the mechanical risks associated with the client's current venous access (single-lumen PICC).
The PICC contains a significant volume of catheter dead space filled with concentrated milrinone.
Flushing the line to clear it would deliver a rapid, unintended bolus of the vasoactive drug, causing severe hypotension.
3
Determine the safest alternative route for medication administration.
A new peripheral IV line must be inserted.
This avoids both drug precipitation and the risk of a vasoactive bolus while ensuring timely administration of the diuretic.

Key Concept

Pharmacological and Parenteral Therapies: Central Line Dead Space and Vasoactive IV Compatibility
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Topics

Pharmacological and Parenteral Therapies

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