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Difficulty: HardPharmacological and Parenteral Therapies

A client admitted with acute decompensated heart failure is receiving a continuous intravenous (IV) infusion of milrinone through a single peripheral IV catheter. The healthcare provider prescribes a stat dose of furosemide via IV push. The nurse consults a drug compatibility reference and notes that furosemide and milrinone are incompatible. Which of the following is the priority nursing action?

  1. Establish a second peripheral IV access site to administer the furosemide.Answer
  2. B
    Stop the milrinone infusion, flush the IV catheter with 0.9% sodium chloride, administer the furosemide, flush again, and immediately restart the milrinone.
  3. C
    Connect the furosemide syringe to the lowest Y-site port on the primary tubing and push the medication slowly.
  4. D
    Request a prescription for oral furosemide since the client only has one patent intravenous access site.

Answer

Establish a second peripheral IV access site to administer the furosemide.
Establishing a second IV site is the only safe option because furosemide and milrinone are incompatible and cannot share a line, and milrinone is a critical vasoactive infusion that must not be interrupted.

Step-by-Step Solution

1
Analyze the prescription and current therapy
The client requires a stat dose of furosemide but is receiving a continuous infusion of milrinone.
Understanding the concurrent medication requirements is the first step in safe administration.
2
Evaluate drug compatibility
Furosemide and milrinone are incompatible and cannot be mixed in the same IV tubing.
Preventing precipitation and embolus formation ensures patient safety.
3
Determine the feasibility of interrupting the primary infusion
Milrinone is a continuous inotropic medication that supports cardiac output; it cannot be safely paused.
Interrupting life-sustaining vasoactive infusions leads to rapid hemodynamic decompensation.
4
Identify the safest alternative
A new, separate IV access site must be established.
This allows both the continuous inotrope to run uninterrupted and the stat diuretic to be given safely.

Key Concept

Management of Incompatible Intravenous Medications and Continuous Vasoactive Infusions
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Topics

Pharmacological and Parenteral Therapies

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