A client admitted with septic shock is currently receiving a continuous intravenous (IV) infusion of pantoprazole through a single peripheral IV catheter. The client's blood pressure drops to with a heart rate of , prompting the healthcare provider to prescribe a stat continuous IV infusion of norepinephrine. Upon checking a pharmacological reference, the nurse discovers that norepinephrine and pantoprazole are incompatible at the Y-site. Which action should the nurse take first?
- AConnect the norepinephrine tubing to the lowest Y-site of the pantoprazole infusion to minimize drug contact time.
- BDelay starting the norepinephrine infusion until a second peripheral IV catheter can be established.
- Pause the pantoprazole, flush the IV catheter with normal saline, and immediately initiate the norepinephrine.Answer
- DDelegate the immediate insertion of a second peripheral IV catheter to the unlicensed assistive personnel.
Answer
The most appropriate action is to pause the pantoprazole infusion, thoroughly flush the intravenous catheter with normal saline, and immediately initiate the norepinephrine infusion.
The client is experiencing profound hypotension associated with septic shock and urgently requires vasopressor support to maintain tissue perfusion. When two incompatible medications are ordered for a client with single intravenous access, the nurse must prioritize the life-saving drug. Pantoprazole (a proton pump inhibitor) can be safely paused while the emergency vasopressor is initiated. The line must be thoroughly flushed with a compatible solution, such as normal saline, before and after the change to prevent chemical precipitation in the tubing or catheter.
Step-by-Step Solution
Key Concept
Prioritization of life-saving intravenous therapies and emergency management of drug incompatibilities.