Examkin

Question

Difficulty: Very hardPharmacological and Parenteral Therapies

A 6565-year-old client is receiving a continuous intravenous (IV) infusion of diltiazem at 15 mg/hr15 \text{ mg/hr} through a single-lumen peripherally inserted central catheter (PICC) for the management of atrial fibrillation. The client suddenly becomes lethargic and diaphoretic. The nurse assesses a heart rate of 32 beats/min32 \text{ beats/min} and a blood pressure of 72/40 mmHg72/40 \text{ mmHg}. The healthcare provider prescribes atropine 1 mg1 \text{ mg} IV push STAT. The client has no other IV access. Which sequence of actions is the safest and most appropriate for the nurse to administer the prescribed atropine?

  1. Stop the diltiazem infusion, aspirate 5 mL5 \text{ mL} of blood from the PICC hub, flush with normal saline, administer the atropine, and flush again.Answer
  2. B
    Stop the diltiazem infusion, immediately flush the PICC with 10 mL10 \text{ mL} of normal saline, administer the atropine, and flush again.
  3. C
    Attach the atropine syringe to the Y-site closest to the client, administer the IV push concurrently with the diltiazem, and then stop the diltiazem pump.
  4. D
    Withhold the atropine and immediately initiate the placement of a new peripheral IV catheter to avoid administering medications through a line containing diltiazem.

Answer

The nurse must first stop the diltiazem infusion, aspirate blood from the PICC hub to clear the residual medication from the catheter dead space, and then flush and administer the atropine.
The correct action safely addresses the medical emergency by prioritizing the administration of the rescue medication while actively preventing further harm. Because the single-lumen PICC is filled with diltiazem (the drug causing the toxicity), the nurse must aspirate the dead space before flushing. This removes the residual drug from the catheter, preventing a rapid bolus of diltiazem from entering the heart.

Step-by-Step Solution

1
Identify the cause of the client's deterioration.
The client is experiencing symptomatic bradycardia and hypotension, which are life-threatening adverse effects of the continuous diltiazem infusion.
Recognizing drug toxicity dictates the immediate cessation of the offending agent.
2
Determine the safest method to administer the rescue medication (atropine) using the existing single-lumen PICC.
The catheter must be cleared of the offending drug before the rescue medication is given.
Central venous catheters have internal volume (dead space) that holds medication. The nurse must not flush this residual medication into the client.
3
Select the correct sequence of line management.
Stop the pump, attach an empty syringe, aspirate 3-5 mL of blood to remove the residual diltiazem, discard the syringe, flush with normal saline, administer the atropine, and flush again.
This sequence ensures the client receives the life-saving atropine rapidly without inadvertently receiving a dangerous bolus of diltiazem.

Key Concept

When converting a central line lumen that is infusing a vasoactive or highly potent medication into a port for an emergent IV push, the nurse must aspirate the catheter's dead space to prevent inadvertently administering a rapid, potentially fatal bolus of the continuous medication.
Estimated Time:2m 0s
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic