Examkin

Question

Difficulty: HardPharmacological and Parenteral Therapies

A nurse is preparing to initiate a continuous intravenous (IV) infusion of regular insulin for a client experiencing diabetic ketoacidosis (DKA). The pharmacy has provided a prepared bag containing 100 units of regular insulin mixed in 100 mL of 0.9% sodium chloride. Which of the following actions must the nurse take when setting up the primary IV tubing for this infusion?

  1. A
    Connect the insulin infusion as a secondary piggyback into the lowest Y-site of a rapidly infusing normal saline bolus.
  2. B
    Vigorously shake the IV bag for at least 30 seconds to ensure the regular insulin is thoroughly mixed with the diluent.
  3. Prime the IV tubing with the insulin solution and discard approximately 50 mL of the fluid before connecting it to the client.Answer
  4. D
    Attach a 1.2-micron in-line filter to the distal end of the IV tubing to prevent the administration of protein precipitates.

Answer

The nurse must prime the intravenous tubing with the insulin solution and discard approximately 50 mL of the fluid before connecting it to the client.
Insulin molecules readily adsorb (bind) to the inner plastic lining of standard polyvinyl chloride (PVC) intravenous tubing. If the tubing is not primed and saturated with the insulin solution prior to connection, the client will receive a significantly lower dose of insulin than prescribed during the crucial initial hours of therapy. Discarding approximately 20 to 50 mL of the primed fluid ensures the tubing's binding sites are completely saturated, allowing for immediate and accurate dose delivery to the client.

Step-by-Step Solution

1
Identify the unique pharmacological properties of regular insulin when administered via a continuous intravenous infusion.
Regular insulin molecules naturally adsorb (bind) to the inner plastic lining of standard polyvinyl chloride (PVC) intravenous tubing.
Understanding this physical interaction is essential to prevent severe under-dosing during the critical initial hours of diabetic ketoacidosis treatment.
2
Determine the required nursing intervention to counteract insulin adsorption to the tubing.
The nurse must prime the tubing with the prepared insulin solution and allow 20 to 50 mL of the fluid to run through and be discarded.
This process fully saturates the binding sites on the PVC tubing, ensuring that the concentration of insulin reaching the client immediately matches the prescribed dose.
3
Evaluate the alternative interventions for safety and adherence to parenteral therapy protocols.
Avoid shaking the bag (which denatures proteins), do not use an unnecessary in-line filter, and never piggyback an insulin drip into a rapidly infusing fluid bolus.
Eliminating unsafe practices guarantees that the high-alert medication is administered correctly without risking cardiovascular collapse or hypoglycemia.

Key Concept

Intravenous Insulin Adsorption and Tubing Saturation
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic