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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is caring for a client with enterococcal endocarditis who is receiving a continuous intravenous (IV) infusion of ampicillin. The healthcare provider prescribes a scheduled dose of IV gentamicin to be infused over 60 minutes. The client has a single-lumen peripherally inserted central catheter (PICC). Knowing that ampicillin and gentamicin are chemically incompatible, which action should the nurse take to safely administer the scheduled dose?

  1. Stop the ampicillin infusion, flush the PICC lumen with 10 mL of 0.9% sodium chloride, infuse the gentamicin, and flush the line again before restarting the ampicillin.Answer
  2. B
    Attach the gentamicin tubing to the Y-site port closest to the client to minimize the time the two medications are in contact within the catheter.
  3. C
    Administer the gentamicin as a direct intravenous push over 3 to 5 minutes while the ampicillin infusion is temporarily paused.
  4. D
    Hold the gentamicin dose and contact the healthcare provider to request the insertion of a second central venous access device.

Answer

The correct action is to stop the continuous ampicillin infusion, flush the line thoroughly with normal saline, administer the gentamicin over the prescribed 60 minutes, and flush the line again before restarting the ampicillin.
When administering an intermittent IV medication that is physically or chemically incompatible with a continuous infusion through a single-lumen catheter, the nurse must utilize sequential administration. This involves stopping the continuous infusion, flushing the line with a compatible fluid (such as 0.9% sodium chloride) to clear the catheter, administering the intermittent medication, and thoroughly flushing the line again before restarting the continuous infusion. This protocol ensures the two medications never physically interact.

Step-by-Step Solution

1
Identify the chemical incompatibility between the continuous ampicillin (a penicillin) and the scheduled gentamicin (an aminoglycoside).
Recognition that these medications cannot be administered concurrently or allowed to mix in the same intravenous line.
Penicillins chemically inactivate aminoglycosides and can form precipitates if they come into contact.
2
Determine the safest administration method given the constraint of a single-lumen PICC line.
Selection of sequential administration utilizing a rigorous flushing protocol.
Flushing with a compatible fluid (0.9% sodium chloride) clears the catheter space of the first medication, allowing safe transit of the second medication without physical contact.

Key Concept

Safe sequential administration of incompatible intravenous medications requires thoroughly flushing the vascular access device with a compatible solution before and after the intermittent dose.
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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