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Difficulty: MediumPharmacological and Parenteral Therapies

An adult client is receiving total parenteral nutrition (TPN) via a single-lumen peripherally inserted central catheter (PICC). The healthcare provider prescribes a scheduled dose of intravenous (IV) famotidine. Which action is most appropriate for the nurse to take?

  1. Establish a new peripheral intravenous access site to administer the prescribed medication.Answer
  2. B
    Pause the parenteral nutrition, flush the catheter with normal saline, administer the medication, and resume the infusion.
  3. C
    Attach the medication syringe to the lowest Y-site port on the primary tubing and push slowly.
  4. D
    Inject the medication directly into the parenteral nutrition bag to ensure simultaneous delivery.

Answer

Establish a new peripheral intravenous access site to administer the prescribed medication.
Total parenteral nutrition (TPN) must be administered through a strictly dedicated intravenous line. Because the client has a single-lumen PICC, no other medications, fluids, or blood products can be administered through this line or its ports. Establishing a new peripheral IV site is the only safe and appropriate way to administer the prescribed famotidine without compromising client safety.

Step-by-Step Solution

1
Identify the type of continuous infusion the client is currently receiving.
The client is receiving total parenteral nutrition (TPN) through a single-lumen central line.
Recognizing the specific fluid is crucial because TPN has strict, highly specialized administration guidelines.
2
Determine the compatibility and administration rules for the primary infusion.
TPN requires a dedicated line and cannot be mixed or Y-sited with other medications.
TPN solutions are highly complex, hypertonic, and prone to life-threatening precipitation and bacterial contamination when mixed with other substances.
3
Select the safest method to administer the newly prescribed medication without compromising the primary infusion.
A separate peripheral intravenous line must be started to administer the famotidine.
Using a separate line ensures the medication is delivered safely while maintaining the integrity and sterility of the client's TPN line.

Key Concept

Total Parenteral Nutrition (TPN) lines must be dedicated solely to TPN administration to prevent dangerous drug incompatibilities and reduce the risk of central line-associated bloodstream infections.
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Topics

Pharmacological and Parenteral Therapies

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