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Difficulty: MediumPharmacological and Parenteral Therapies

Following a complicated vaginal delivery, a client develops an acute postpartum hemorrhage. The healthcare provider prescribes an immediate transfusion of packed red blood cells (PRBCs). The client has one functioning 18-gauge intravenous (IV) catheter in the right forearm, which is currently delivering a continuous infusion of lactated Ringer's solution mixed with 30 units of oxytocin. Which of the following actions should the nurse take?

  1. Insert a second peripheral intravenous catheter to transfuse the packed red blood cells.Answer
  2. B
    Route the blood administration set through the lowest Y-site port of the active lactated Ringer's line.
  3. C
    Temporarily stop the oxytocin infusion, flush the line with 0.9% sodium chloride, and begin the transfusion.
  4. D
    Delay the blood administration until the continuous oxytocin infusion is complete.

Answer

Insert a second peripheral intravenous catheter to transfuse the packed red blood cells.
The correct action is to insert a second peripheral intravenous catheter. Packed red blood cells (PRBCs) are incompatible with Lactated Ringer's solution because the calcium in the fluid can cause the blood to clot within the IV tubing. Furthermore, the client requires the continuous oxytocin infusion to manage the postpartum hemorrhage. Pausing the oxytocin would cause the uterus to relax and worsen the bleeding. Therefore, a separate, dedicated line is required to safely administer the PRBCs concurrently with the oxytocin.

Step-by-Step Solution

1
Evaluate the compatibility of the prescribed blood product with the currently infusing intravenous fluid.
Lactated Ringer's solution contains calcium, which is strictly incompatible with packed red blood cells because it causes the blood to coagulate in the tubing.
Ensuring fluid compatibility prevents life-threatening complications such as thromboembolism and blocked IV access.
2
Determine if the primary infusion (oxytocin) can be safely interrupted.
The client is experiencing a postpartum hemorrhage, requiring continuous oxytocin to maintain uterine tone and control bleeding; the infusion cannot be stopped.
Interrupting a critical vasoactive or uterotonic medication compromises patient stability and exacerbates the emergency.
3
Identify the safest alternative for medication delivery.
A second large-bore intravenous line must be initiated to allow for the independent, simultaneous administration of the blood product with 0.9% sodium chloride.
This approach ensures both the treatment for uterine atony (oxytocin) and the treatment for acute anemia (PRBCs) are safely and continuously delivered.

Key Concept

Blood Transfusion Compatibility and Priority of Care in Hemorrhage
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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