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Difficulty: MediumPharmacological and Parenteral Therapies

A client with severe Crohn's disease is receiving a continuous infusion of total parenteral nutrition (TPN) through a single-lumen peripherally inserted central catheter (PICC). The healthcare provider prescribes intermittent intravenous (IV) ceftriaxone 1 g1\text{ g} every 12 hours12\text{ hours}. Which action represents the safest practice for administering this antibiotic?

  1. Initiate a separate peripheral IV access site to administer the antibiotic.Answer
  2. B
    Connect the antibiotic as a secondary piggyback to the Y-site of the continuous infusion.
  3. C
    Pause the continuous nutrition infusion, flush the line with normal saline, administer the antibiotic, and resume the nutrition.
  4. D
    Add the prescribed dose of the antibiotic directly into the total parenteral nutrition bag.

Answer

The nurse should initiate a separate peripheral IV access site to administer the antibiotic.
Total parenteral nutrition (TPN) contains a complex mixture of amino acids, dextrose, lipids, vitamins, and minerals. Because of its hypertonicity and high glucose content, TPN must run through a dedicated central line to prevent severe complications such as drug-drug incompatibilities, microvascular precipitates, and central line-associated bloodstream infections (CLABSI). The safest and most appropriate nursing action is to start a new, separate peripheral IV line exclusively for the administration of the prescribed antibiotic.

Step-by-Step Solution

1
Identify the primary therapy currently being administered to the client.
The client is receiving total parenteral nutrition (TPN) via a single-lumen PICC.
Understanding the current infusion is critical for determining compatibility and line access requirements.
2
Recall the standard safety principles for administering TPN.
TPN must always be administered through a dedicated line. Other medications or fluids should not be mixed or Y-sited with TPN.
TPN solutions are complex mixtures with a high risk of precipitation when mixed with other drugs, and the high glucose content increases the risk of central line infections if the system is frequently accessed.
3
Determine the most appropriate method to administer the newly prescribed IV antibiotic.
Since the only current access is a single-lumen dedicated TPN line, a new separate peripheral IV access must be established.
This ensures the client receives the necessary antibiotic safely without compromising the TPN infusion or risking incompatibility.

Key Concept

Total Parenteral Nutrition (TPN) Administration and Line Safety
Estimated Time:1m 0s
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Topics

Pharmacological and Parenteral Therapies

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