A client with severe decompensated heart failure is admitted to the intensive care unit with a double-lumen peripherally inserted central catheter (PICC) in place. Lumen 1 is infusing continuous dobutamine, and Lumen 2 is infusing continuous sodium chloride. The healthcare provider prescribes stat intravenous (IV) furosemide, a continuous IV heparin infusion, and a scheduled dose of IV potassium chloride. Which actions by the nurse are appropriate? Select all that apply.
- Administer the stat IV furosemide through Lumen 2 after flushing the port with sodium chloride.Answer
- BTemporarily pause the continuous dobutamine infusion to administer the stat IV furosemide through Lumen 1.
- Verify the physical compatibility of the continuous heparin infusion with sodium chloride before connecting it to Lumen 2.Answer
- DSet the infusion pump to deliver the IV potassium chloride at a rate of to ensure rapid therapeutic effect.
- EConnect the continuous heparin infusion to the Y-site of the dobutamine infusion to reserve the other lumen for intermittent medications.
- Evaluate the client's continuous electrocardiogram (ECG) rhythm and baseline serum creatinine prior to initiating the potassium chloride.Answer
Answer
The nurse should administer the furosemide through Lumen 2 after flushing, verify the compatibility of heparin with the normal saline in Lumen 2, and evaluate the ECG rhythm and renal function before giving the potassium chloride.
Safe central line management and pharmacology principles require the nurse to protect dedicated lines for vasoactive infusions, thoroughly verify fluid compatibility before Y-site administration, flush lines adequately between intermittent medications, and apply rigorous monitoring and rate limits to high-alert electrolytes like potassium chloride.
Step-by-Step Solution
Key Concept
Safe administration of parenteral therapies requires continuous maintenance of critical inotropes, strict verification of IV compatibility, and adherence to high-alert medication administration parameters.