A client in the intensive care unit is receiving a continuous intravenous (IV) infusion of norepinephrine via a central venous catheter for profound septic shock. The smart infusion pump abruptly alarms with a "Distal Occlusion" alert. The client's mean arterial pressure (MAP) drops from 68 mm Hg to 52 mm Hg. The nurse quickly traces the external tubing and finds no closed clamps or kinks. To prevent severe client injury, which action must the nurse take next?
- Disconnect the IV tubing and gently aspirate from the central catheter hub using an empty syringe to remove the potential micro-thrombus.Answer
- BAttach a 10 mL syringe of 0.9% sodium chloride and apply firm, steady pressure to the hub to dislodge the clot and restore the infusion.
- CDelegate the unlicensed assistive personnel (UAP) to immediately gather and prepare a new peripheral IV insertion kit at the bedside.
- DDon a full sterile gown, mask, and sterile gloves prior to manipulating the central line connections to prevent a bloodstream infection.
Answer
The nurse must gently aspirate from the central catheter hub using an empty syringe to attempt to clear the occlusion.
The correct action addresses the mechanical occlusion without introducing a lethal pharmacological risk. When a central line infusing a high-concentration vasoactive medication (like norepinephrine) occludes, a significant amount of the potent drug remains trapped in the catheter's internal lumen. The nurse must gently aspirate to remove the clot and the trapped drug. Flushing the line is strictly contraindicated, as it would push the concentrated medication bolus directly into the central circulation, potentially precipitating a fatal cardiac event.
Step-by-Step Solution
Key Concept
Prevention of high-alert medication boluses during intravenous catheter troubleshooting.