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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is preparing to administer an initial prescribed dose of intravenous amphotericin B deoxycholate 50 mg50\text{ mg} in 500 mL500\text{ mL} of 5%5\% dextrose in water (D5W) to a client with a severe systemic fungal infection. The medication is scheduled to infuse over 4 hours. The client currently has a single peripheral intravenous (IV) catheter with a continuous infusion of 0.9%0.9\% sodium chloride running at 75 mL/hr75\text{ mL/hr}. Which sequence of actions is the safest and most appropriate for the nurse to implement?

  1. Pause the 0.9%0.9\% sodium chloride infusion, flush the IV catheter with D5W, administer the amphotericin B at 125 mL/hr125\text{ mL/hr}, and flush again with D5W before restarting the saline.Answer
  2. B
    Discontinue the 0.9%0.9\% sodium chloride, flush the IV catheter with 10 mL10\text{ mL} of 0.9%0.9\% sodium chloride, administer the amphotericin B at 125 mL/hr125\text{ mL/hr}, and flush again with 0.9%0.9\% sodium chloride.
  3. C
    Attach the amphotericin B tubing to the lowest Y-site of the primary 0.9%0.9\% sodium chloride line and program the secondary infusion pump to 125 mL/hr125\text{ mL/hr}.
  4. D
    Pause the 0.9%0.9\% sodium chloride infusion, flush the IV catheter with D5W, and administer the amphotericin B at an infusion pump rate of 12.5 mL/hr12.5\text{ mL/hr}.

Answer

The nurse must pause the 0.9%0.9\% sodium chloride infusion, flush the line with D5W, infuse the amphotericin B at 125 mL/hr125\text{ mL/hr}, and flush again with D5W before resuming the saline.
Amphotericin B deoxycholate is highly incompatible with saline solutions and will form a precipitate if mixed. Because the client has only one IV site, the continuous saline infusion must be paused, and the line must be thoroughly flushed with 5%5\% dextrose in water (D5W) prior to and following the medication administration. The correct infusion rate is calculated by dividing the total volume (500 mL500\text{ mL}) by the total time (4 hours4\text{ hours}), resulting in 125 mL/hr125\text{ mL/hr}.

Step-by-Step Solution

1
Identify the IV compatibility of the prescribed medication.
Amphotericin B deoxycholate is incompatible with 0.9%0.9\% sodium chloride and must be mixed and flushed exclusively with 5%5\% dextrose in water (D5W).
Mixing amphotericin B with saline causes precipitation, which can lead to catheter occlusion or an embolism.
2
Determine the appropriate line management strategy for a single IV access.
The continuous saline infusion must be paused, and the IV line must be completely cleared of saline by flushing with D5W before and after the amphotericin B infusion.
This ensures the incompatible solutions do not meet within the catheter lumen.
3
Calculate the correct infusion pump rate in mL/hr.
Divide the total volume (500 mL500\text{ mL}) by the prescribed infusion time (4 hours4\text{ hours}) to yield a rate of 125 mL/hr125\text{ mL/hr}.
Infusion pumps are programmed based on fluid volume over time, not medication dosage over time.

Key Concept

Amphotericin B IV Compatibility and Safe Administration
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Topics

Pharmacological and Parenteral Therapies

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