A nurse is preparing to administer a prescribed intravenous (IV) push medication through a… — NCLEX-RN

A nurse is preparing to administer a prescribed intravenous (IV) push medication through a client's peripheral IV line. The client currently has a continuous primary IV infusion of a solution that is physically incompatible with the ordered IV push medication. In what order should the nurse perform the following actions to safely administer the medication? Arrange the steps from first to last.

1Stop the primary continuous IV infusion pump.
2Clamp the primary IV tubing just above the injection port closest to the client.
3Scrub the needleless connector and flush the port with $10\text{ mL}$ of sterile $0.9\%$ sodium chloride.
4Administer the prescribed IV push medication over the manufacturer's recommended time.
5Flush the port again with $10\text{ mL}$ of $0.9\%$ sodium chloride at the same rate as the medication administration.
6Unclamp the primary IV tubing and restart the continuous IV infusion pump.

Answer

The correct sequence involves stopping the incompatible fluid, clamping the line to direct flow, flushing to clear the catheter, administering the medication, flushing again at the appropriate rate to clear residual drug, and finally restarting the primary fluid.

When administering an IV push medication through a line infusing an incompatible solution, the nurse must completely separate the two substances. The sequence starts with halting the pump and clamping the line to prevent retrograde flow. The first saline flush clears the line of the incompatible solution. The medication is then administered at the correct rate. Crucially, the second flush must be administered at the exact same rate as the medication to ensure the residual drug in the catheter is not pushed in too quickly. Finally, the line is unclamped and the pump is restarted.

Step-by-Step Solution

Stop the primary continuous IV infusion pump.

Incompatible fluid flow is halted.

Prevents the incompatible primary fluid from advancing into the lower tubing during preparation.

Clamp the primary IV tubing just above the injection port closest to the client.

Backward flow into the primary tubing is blocked.

Ensures that all injected fluids (flush and medication) are directed entirely into the client's vein rather than up the primary line.

Scrub the needleless connector and flush the port with

10\text{ mL}

of sterile

0.9\%

sodium chloride.

The IV catheter is cleared of incompatible fluid.

Prevents physical incompatibility (precipitation/crystallization) between the primary solution and the IV push medication.

Administer the prescribed IV push medication over the manufacturer's recommended time.

Therapeutic dose is delivered.

Ensures the medication is delivered safely according to pharmacological guidelines.

Flush the port again with

10\text{ mL}

0.9\%

sodium chloride at the same rate as the medication administration.

Residual medication in the catheter is cleared into the bloodstream.

Clears the medication from the catheter. Doing this at the same rate prevents the residual medication from being pushed into the circulation too rapidly (preventing speed shock).

Unclamp the primary IV tubing and restart the continuous IV infusion pump.

Primary continuous therapy is resumed.

Re-establishes the prescribed continuous maintenance or therapeutic IV fluids once the line is completely clear.

Key Concept

Safe administration of IV push medications through an incompatible infusing line requires strict isolation using a "flush-administer-flush" technique, with specific attention to clamping and flush administration rates.

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