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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a hemodynamically unstable client with septic shock. The client is receiving a continuous intravenous (IV) infusion of norepinephrine through a single 20-gauge peripheral IV line to maintain a mean arterial pressure (MAP) greater than 65 mm Hg. The healthcare provider prescribes a stat dose of intravenous piperacillin-tazobactam. Which action by the nurse is the most appropriate?

  1. Insert a second peripheral intravenous line to administer the prescribed antibiotic.Answer
  2. B
    Attach the antibiotic as a secondary piggyback infusion to the existing intravenous line.
  3. C
    Pause the norepinephrine infusion, flush the line, administer the antibiotic, and restart the infusion.
  4. D
    Delegate the insertion of a second intravenous line to the unlicensed assistive personnel (UAP) to expedite medication delivery.

Answer

Insert a second peripheral intravenous line to administer the prescribed antibiotic.
The correct action involves establishing a separate intravenous line. Norepinephrine is a critical, high-alert vasoactive medication that must be infused continuously at a precisely titrated rate to maintain the client's blood pressure. Administering another medication through the same line—either by piggybacking or pausing the infusion—alters the delivery rate of the vasopressor. This can cause a sudden, dangerous bolus of the drug to reach the patient or result in a life-threatening drop in blood pressure. Therefore, a dedicated line is absolutely required.

Step-by-Step Solution

1
Analyze the client's physiological status and current therapies.
The client is in septic shock and is dependent on a continuous vasopressor (norepinephrine) to maintain basic organ perfusion.
To identify contraindications for altering the current intravenous therapy setup.
2
Evaluate the proposed intervention against safety protocols.
The stat antibiotic needs to be administered immediately, but it cannot interrupt or alter the flow rate of the continuous vasopressor.
To determine the safest route of administration without compromising hemodynamic stability.
3
Select the most appropriate nursing action.
Establishing a new, separate peripheral IV line is required.
To ensure both the life-sustaining vasopressor and the critical antibiotic are delivered safely without interfering with each other's flow rates.

Key Concept

Safe administration of parenteral therapies requires a dedicated intravenous line for titrated vasoactive continuous infusions to prevent dangerous hemodynamic fluctuations.
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Topics

Pharmacological and Parenteral Therapies

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