Examkin

Question

Difficulty: HardPharmacological and Parenteral Therapies

A nurse is caring for a client with a confirmed pulmonary embolism who is receiving a continuous intravenous (IV) infusion of heparin at 18 units/kg/hr18 \text{ units/kg/hr} through a single-lumen peripheral venous catheter. The healthcare provider prescribes a scheduled dose of IV levofloxacin 500 mg500 \text{ mg} to infuse over 60 minutes60 \text{ minutes} for a concurrent bacterial pneumonia. Upon reviewing a pharmacological reference, the nurse discovers that heparin and levofloxacin are physically incompatible. Which of the following is the most appropriate action by the nurse?

  1. Insert a new peripheral venous catheter in a different extremity to administer the levofloxacin.Answer
  2. B
    Stop the heparin infusion, flush the catheter with normal saline, infuse the levofloxacin, flush again, and resume the heparin.
  3. C
    Attach the levofloxacin secondary tubing to the primary tubing Y-site port closest to the client's insertion site.
  4. D
    Administer the levofloxacin simultaneously with the heparin by utilizing a dual-channel intravenous infusion pump.

Answer

Insert a new peripheral venous catheter in a different extremity to administer the levofloxacin.
The correct action is to establish a new peripheral intravenous access site. Because heparin and levofloxacin are physically incompatible, they cannot be mixed in the same IV tubing or single-lumen catheter without risking crystallization and precipitation. Furthermore, because heparin is a critical high-alert medication with a very short half-life, pausing the infusion for the 60 minutes required to administer the antibiotic would place the client at immediate risk for thrombus extension.

Step-by-Step Solution

1
Analyze the pharmacological properties of the current continuous infusion.
Heparin has a very short half-life and is critical for preventing thrombus extension in a client with a pulmonary embolism.
To determine if the infusion can be safely interrupted for secondary medication administration.
2
Evaluate the physical compatibility of the prescribed medications.
Heparin and levofloxacin are physically incompatible.
To determine if the medications can be administered simultaneously through the same intravenous line.
3
Formulate a safe administration plan based on the client's vascular access.
The client only has a single-lumen catheter. A second intravenous access site must be established.
Mixing incompatible drugs causes precipitation, and pausing a critical heparin infusion for 60 minutes severely compromises patient safety.

Key Concept

Intravenous Medication Compatibility and Continuous Infusion Safety
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic