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Difficulty: MediumPharmacological and Parenteral Therapies

An adult client receiving a continuous 0.9%0.9\% sodium chloride infusion at 75 mL/hr75\text{ mL/hr} through a single peripheral venous catheter is prescribed a dose of intravenous amphotericin B for a severe fungal infection. Before hanging the antifungal medication, which action must the nurse prioritize to ensure safe administration?

  1. A
    Connect the secondary medication tubing directly to the lowest Y-site port on the running 0.9%0.9\% sodium chloride line.
  2. B
    Withhold the medication and prioritize reviewing the client's morning complete blood count results before proceeding.
  3. Pause the primary fluid and flush the intravenous line thoroughly with 5%5\% dextrose in water before and after the medication.Answer
  4. D
    Calculate the infusion rate to deliver the medication as a rapid intravenous bolus over 55 minutes to quickly achieve therapeutic levels.

Answer

The correct action is to pause the primary normal saline fluid and flush the line thoroughly with 5% dextrose in water both before and after administering the medication.
Amphotericin B is chemically incompatible with saline solutions (such as 0.9%0.9\% sodium chloride) and will form a precipitate if they are allowed to mix. To safely administer this medication through a single intravenous line that has been infusing saline, the nurse must pause the saline infusion and thoroughly flush the line with 5%5\% dextrose in water (D5W) both before and after the amphotericin B infusion.

Step-by-Step Solution

1
Identify the continuous intravenous fluid currently infusing.
The client is receiving 0.9% sodium chloride (normal saline).
Establishing the baseline fluid is necessary to determine compatibility with the newly prescribed intravenous medication.
2
Determine the chemical compatibility of amphotericin B with the current intravenous fluid.
Amphotericin B is chemically incompatible with 0.9% sodium chloride.
Mixing incompatible medications or fluids causes precipitation, which can permanently occlude the catheter or cause a life-threatening embolus.
3
Select the appropriate nursing intervention for administering an incompatible medication through a single line.
The line must be cleared of saline using a compatible flush solution, which for amphotericin B is 5% dextrose in water (D5W).
Thorough flushing before and after the infusion prevents the two incompatible solutions from ever mixing within the intravenous tubing.

Key Concept

Safe administration of intravenous amphotericin B and prevention of chemical incompatibility.
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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