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Difficulty: HardPharmacological and Parenteral Therapies

A nurse in the intensive care unit is managing a critically ill client diagnosed with septic shock. The client is currently supported by a continuous intravenous (IV) infusion of norepinephrine via a single peripheral catheter. Recent arterial blood gas results reveal a pH of 7.15 and an HCO3−HCO_3^- of 14 mEq/L (14 mmol/L). The healthcare provider prescribes an immediate IV bolus of sodium bicarbonate. Which of the following is the most appropriate action by the nurse?

  1. A
    Connect the sodium bicarbonate to the Y-site port closest to the client's IV insertion site and deliver the bolus over 5 minutes.
  2. B
    Halt the vasopressor pump briefly, clear the line with a 0.9% sodium chloride flush, deliver the prescribed bolus, and resume the continuous infusion.
  3. Initiate a separate peripheral intravenous access site to deliver the alkaline solution without interrupting the vasopressor support.Answer
  4. D
    Notify the prescribing provider to suggest switching the medication to an oral formulation, as the client's current access is dedicated to a high-alert medication.

Answer

Initiate a separate peripheral intravenous access site to deliver the alkaline solution without interrupting the vasopressor support.
Norepinephrine is a critical, life-sustaining vasopressor with a very short half-life. It must be infused continuously; pausing it can lead to immediate and severe hemodynamic collapse. Furthermore, norepinephrine is chemically incompatible with alkaline solutions such as sodium bicarbonate, which rapidly deactivate catecholamines. Therefore, the safest and most appropriate action is to establish a new, separate intravenous line to administer the sodium bicarbonate without interrupting the vasopressor.

Step-by-Step Solution

1
Analyze the client's clinical status and ongoing therapies.
The client is experiencing septic shock and severe metabolic acidosis, relying on a continuous norepinephrine infusion to maintain perfusion.
Recognizing the critical nature of the vasopressor establishes that the infusion cannot be safely interrupted.
2
Evaluate the physical and chemical compatibility of the prescribed medications.
Sodium bicarbonate is a strongly alkaline solution that is chemically incompatible with catecholamines like norepinephrine.
Administering incompatible medications through the same line risks drug degradation, precipitation, or loss of therapeutic effect.
3
Determine the safest administration strategy based on priorities.
A new, dedicated IV line must be inserted.
This intervention allows for the simultaneous administration of the urgently needed buffer (sodium bicarbonate) and uninterrupted hemodynamic support (norepinephrine).

Key Concept

Safe Administration of Incompatible High-Alert Intravenous Medications
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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