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Difficulty: HardPharmacological and Parenteral Therapies

A client recovering from abdominal surgery reports a pain level of 8 on a 0-to-10 scale. The healthcare provider has ordered 2 mg2 \text{ mg} of morphine sulfate to be administered via intravenous push over 4 minutes. The client currently has a continuous infusion of 0.9% sodium chloride0.9\% \text{ sodium chloride} running at 75 mL/hr75 \text{ mL/hr} through a peripheral catheter. The nurse accesses the injection port closest to the client. Which technique represents the safest method for administering this medication?

  1. A
    Pinch the primary tubing above the injection port continuously for the entire 4 minutes while slowly injecting the medication.
  2. Pinch the primary tubing above the injection port, inject a small increment of the medication, release the tubing to allow the primary fluid to flow, and repeat this process over 4 minutes.Answer
  3. C
    Pause the primary infusion pump, inject the medication continuously over 4 minutes, and then immediately restart the pump.
  4. D
    Inject the medication continuously into the port over 4 minutes without pinching the primary tubing above the injection site.

Answer

The safest method is to sequentially pinch the primary tubing, inject a small increment, release the tubing, and repeat the process over the required duration.
The correct answer utilizes the 'pinch-push-release' method. By pinching the tubing above the port, the nurse prevents the medication from flowing backward up the primary line. Injecting a small increment and then releasing the pinch allows the continuous sodium chloride infusion to flush that fraction of the medication directly into the vein. Repeating this cycle over the prescribed 4 minutes ensures a safe, steady delivery and prevents a sudden bolus effect.

Step-by-Step Solution

1
Analyze the prescribed administration rate and the existing intravenous setup.
The medication must be given slowly over 4 minutes into a line with a continuous carrier fluid.
Rapid administration of opioids can cause severe adverse effects, such as respiratory depression and severe hypotension (speed shock).
2
Evaluate the mechanics of intravenous fluid dynamics when injecting into a continuous line.
Medication injected into a port will follow the path of least resistance. Without pinching the tubing above the port, the medication may travel upward into the primary tubing.
Preventing retrograde flow ensures the entire dose goes toward the client.
3
Determine the effect of dead space in the intravenous tubing between the port and the insertion site.
If the primary line is pinched continuously or stopped, the injected medication stays in this dead space.
To ensure the medication actually reaches the systemic circulation progressively over the 4 minutes, the carrier fluid must be intermittently allowed to flow and flush the small increments into the vein.

Key Concept

Intravenous Push Administration via Continuous Infusion
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Topics

Pharmacological and Parenteral Therapies

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