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Difficulty: MediumPharmacological and Parenteral Therapies

A client admitted with acute decompensated heart failure is receiving a continuous intravenous infusion of dobutamine for inotropic support. During the shift, the client suddenly exhibits severe dyspnea, a respiratory rate of 34 breaths per minute, and bilateral coarse crackles on auscultation. The provider verbally orders 40 mg of furosemide to be administered via direct intravenous injection immediately. The client currently has only one functioning 20-gauge peripheral venous catheter. Which action is the priority for the registered nurse to safely administer this medication?

  1. A
    Inject the medication directly into the most proximal y-site port of the primary continuous infusion tubing.
  2. B
    Stop the inotropic pump temporarily, flush the catheter with sodium chloride, deliver the diuretic, and immediately restart the pump.
  3. Establish an additional peripheral vascular access site to administer the diuretic independently.Answer
  4. D
    Direct the unlicensed assistive personnel to continuously monitor the client's oxygen saturation and blood pressure.

Answer

The nurse must establish an additional peripheral vascular access site to administer the furosemide independently.
The correct action is to establish a new vascular access site. Furosemide is chemically incompatible with dobutamine and will precipitate if mixed in the same tubing. Additionally, dobutamine is a critical vasoactive medication providing essential inotropic support for a client in acute decompensated heart failure. Pausing the dobutamine infusion to flush the line and administer the furosemide could cause a rapid, life-threatening deterioration in the client's cardiac output and blood pressure. Therefore, obtaining separate access is the only safe method to deliver the stat medication without compromising the client's circulatory status.

Step-by-Step Solution

1
Analyze the client's clinical status and the current intravenous setup.
The client is hemodynamically dependent on a continuous dobutamine infusion and has only one peripheral access site.
Understanding the client's dependence on the continuous medication dictates whether the line can be safely interrupted.
2
Evaluate the chemical compatibility of the prescribed intravenous push medication with the primary continuous infusion.
Furosemide and dobutamine are identified as physically and chemically incompatible.
Administering incompatible medications through the same line can cause precipitation, emboli, and altered drug efficacy.
3
Determine the safest administration route considering compatibility and prioritization.
Since the drugs are incompatible and the dobutamine cannot be safely paused, a new intravenous access site must be established.
This approach ensures the stat diuretic is given promptly without interrupting critical inotropic support or causing a hazardous drug interaction.

Key Concept

Intravenous medication compatibility and the management of continuous vasoactive infusions.
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Topics

Pharmacological and Parenteral Therapies

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