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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is preparing to administer an intravenous (IV) push medication that is incompatible with the client's continuous IV fluid infusion. The client has a single peripheral IV access. Arrange the following actions in the correct sequence to safely administer this medication. (Place the first action at the top and the last action at the bottom.)

  1. 1Stop the continuous intravenous infusion pump.
  2. 2Clamp the primary intravenous tubing above the injection port closest to the client.
  3. 3Scrub the injection port hub, aspirate for blood return, and flush with normal saline.
  4. 4Administer the prescribed intravenous push medication over the recommended time.
  5. 5Flush the injection port with normal saline at the same rate the medication was administered.
  6. 6Unclamp the primary intravenous tubing and restart the continuous infusion.

Answer

The correct sequence is to first stop the continuous infusion, clamp the tubing above the lowest port, scrub the hub and flush with saline to clear the line, administer the medication over the prescribed time, flush again with saline at the same slow rate as the medication, and finally unclamp and restart the infusion.
Safely administering an IV push medication into a line with an incompatible continuous infusion requires creating a saline barrier and preventing the two medications from mixing. By stopping the pump and clamping the tubing, the nurse prevents retrograde flow. Flushing with saline before and after the medication creates a liquid barrier. Most importantly, flushing after the medication at the same slow rate is critical to prevent a rapid bolus of the medication remaining in the tubing's dead space.

Step-by-Step Solution

1
Stop the continuous intravenous infusion pump.
The active flow of the incompatible fluid is halted.
It is critical to stop the incompatible fluid from infusing while the line is being manipulated and flushed.
2
Clamp the primary intravenous tubing above the injection port closest to the client.
The pathway back into the main IV bag and tubing is blocked.
Clamping prevents the subsequent flush and medication from traveling backward up the tubing (retrograde flow) and mixing with the incompatible primary fluid.
3
Scrub the injection port hub, aspirate for blood return, and flush with normal saline.
The line from the port to the vein is cleared of incompatible fluid.
This establishes a sterile access point, confirms venous placement, and creates a physical saline barrier between the incompatible fluids.
4
Administer the prescribed intravenous push medication over the recommended time.
The medication is safely delivered into the vein.
Pushing the medication slowly over the recommended duration prevents toxicity and severe adverse reactions.
5
Flush the injection port with normal saline at the same rate the medication was administered.
The residual medication in the IV tubing is pushed into the bloodstream at a safe speed.
Flushing too rapidly will forcefully push the medication occupying the dead space of the tubing into the client, essentially administering a rapid bolus and risking speed shock.
6
Unclamp the primary intravenous tubing and restart the continuous infusion.
The continuous therapy is resumed.
Once the medication is safely cleared from the line, it is safe to restart the primary continuous infusion.

Key Concept

Safe administration of an intravenous push medication through a line with an incompatible continuous infusion.
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Topics

Pharmacological and Parenteral Therapies

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