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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a critically ill client who has a double-lumen central venous catheter (CVC). The client is receiving a continuous intravenous (IV) infusion of norepinephrine through the distal lumen for hemodynamic support. The healthcare provider prescribes a scheduled dose of IV push furosemide and an intermittent IV infusion of piperacillin-tazobactam. Which of the following actions should the nurse take? (Select all that apply.)

  1. Scrub the needleless connector hub of the proximal lumen with an appropriate antiseptic friction rub for at least 1515 seconds prior to access.Answer
  2. Administer the intermittent piperacillin-tazobactam infusion through the proximal lumen using an electronic infusion pump.Answer
  3. Flush the proximal lumen with a 0.9%0.9\% sodium chloride solution before and after administering the IV push furosemide.Answer
  4. D
    Pause the continuous norepinephrine infusion briefly to administer the IV push furosemide through the distal lumen.
  5. E
    Calculate the continuous norepinephrine drip rate based on the client's estimated admission weight.
  6. F
    Delegate the routine assessment of the CVC insertion site for signs of infection to the unlicensed assistive personnel (UAP).

Answer

The safe and appropriate actions include scrubbing the needleless connector hub for at least 1515 seconds prior to access, administering the antibiotic through the unused proximal lumen, and flushing the lumen with 0.9%0.9\% sodium chloride before and after IV push administration.
Safe parenteral therapy through a multi-lumen CVC requires maintaining the continuity of life-sustaining infusions, utilizing strict aseptic technique during access, and ensuring line patency. Separate lumens exit at different points in the vein, allowing for the simultaneous administration of incompatible or critical medications without interruption or precipitation.

Step-by-Step Solution

1
Identify the critical nature of the continuous infusion.
Norepinephrine is a life-sustaining vasoactive drip.
Interrupting a vasopressor can cause rapid hemodynamic collapse, so the distal lumen must remain dedicated to this infusion.
2
Determine the safe route for the new intermittent medications.
The unused proximal lumen of the double-lumen CVC will be utilized.
Multi-lumen catheters have separate internal channels that exit at different points in the vein, allowing incompatible medications to be administered simultaneously without mixing inside the catheter.
3
Apply standard central line infection prevention and maintenance protocols.
Scrub the hub for at least 1515 seconds and perform routine saline flushes.
Scrubbing the hub prevents CLABSI, while flushing before and after IV push medications confirms patency and clears the line of residual drug.
4
Evaluate delegation and dosage safety principles.
Assessments cannot be delegated, and exact weight must be used for dosing.
RNs retain responsibility for all clinical assessments, and estimated weights are unsafe for titrating critical care drips.

Key Concept

Management of Multi-Lumen Central Venous Catheters and High-Alert Medications
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Topics

Pharmacological and Parenteral Therapies

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