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Difficulty: MediumPharmacological and Parenteral Therapies

A client admitted with a deep vein thrombosis is receiving a continuous intravenous infusion of heparin through a single-lumen peripheral catheter. The client is experiencing severe pain from an unrelated surgical incision, and the healthcare provider prescribes an as-needed dose of intravenous morphine. After consulting a drug reference guide and determining that morphine and heparin are chemically incompatible at the Y-site, which of the following actions should the nurse take?

  1. Insert a second peripheral intravenous catheter in a different location to administer the prescribed morphine.Answer
  2. B
    Stop the heparin infusion pump, flush the line with 0.9% sodium chloride, administer the morphine, and flush again.
  3. C
    Connect the morphine syringe to the Y-site injection port closest to the client and administer the medication slowly.
  4. D
    Piggyback the morphine into the primary heparin tubing using a secondary intravenous set above the infusion pump.

Answer

Insert a second peripheral intravenous catheter in a different location to administer the prescribed morphine.
Heparin and morphine are chemically incompatible and cannot be mixed in the same intravenous tubing. When a client has a continuous infusion of a high-alert medication running through a single-lumen catheter, the line should never be paused and flushed to administer another drug. Flushing the tubing would deliver the concentrated heparin resting in the dead space as a rapid, unintended bolus, placing the client at severe risk for hemorrhage. Therefore, the only safe and appropriate action is to establish a second, dedicated peripheral IV site to administer the morphine.

Step-by-Step Solution

1
Identify the incompatibility and its clinical implications.
The nurse recognizes that heparin and morphine are chemically incompatible and cannot be mixed in the same IV tubing.
Mixing incompatible medications can cause crystallization and precipitate formation, potentially leading to a harmful embolism or catheter occlusion.
2
Evaluate alternative methods for using the existing IV line.
The nurse determines that pausing the infusion and flushing the line is strictly contraindicated for this specific therapy.
Flushing a line that contains a high-concentration continuous medication (like heparin) inadvertently delivers a rapid bolus of the drug resting in the tubing into the client's bloodstream. It also inappropriately interrupts continuous therapeutic anticoagulation.
3
Establish a safe administration route for the newly prescribed medication.
The nurse inserts a new, separate peripheral IV catheter.
A dedicated secondary access site ensures the client receives immediate pain relief without compromising the safety or efficacy of the high-alert heparin infusion.

Key Concept

Safe administration of incompatible medications and management of high-alert continuous infusions
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Topics

Pharmacological and Parenteral Therapies

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