A client admitted with an active upper gastrointestinal bleed is receiving a continuous intravenous (IV) infusion of pantoprazole. The healthcare provider prescribes a scheduled dose of IV ciprofloxacin for a concurrent urinary tract infection. The client has a single peripheral IV catheter. The nurse consults the facility's drug compatibility reference and notes that pantoprazole and ciprofloxacin are physically incompatible. Which action by the nurse is the most appropriate?
- APause the continuous pantoprazole infusion, flush the line with normal saline, infuse the ciprofloxacin, flush again, and resume the pantoprazole.
- Insert a second peripheral intravenous catheter to administer the ciprofloxacin.Answer
- CAdminister the ciprofloxacin concurrently by connecting it to the Y-site closest to the client's venous access.
- DInfuse both medications through the existing line and delegate the unlicensed assistive personnel (UAP) to monitor the site for crystal formation.
Answer
The most appropriate action is to insert a second peripheral intravenous catheter to administer the ciprofloxacin.
When a client is receiving a continuous critical infusion (such as pantoprazole for an active GI bleed) and requires a secondary medication that is physically incompatible, the nurse must insert a second IV catheter. Pantoprazole continuous infusions are used to maintain a gastric pH above 6.0, which stabilizes platelet aggregates and prevents rebleeding. Pausing this infusion for an hour to administer ciprofloxacin would place the client at high risk for hemorrhage. Mixing the incompatible medications will cause precipitation. Therefore, a new IV line is the only safe solution.
Step-by-Step Solution
Key Concept
Management of incompatible intravenous medications when continuous critical infusions are prescribed.