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Difficulty: MediumPharmacological and Parenteral Therapies

While receiving total parenteral nutrition (TPN) through a single-lumen peripherally inserted central catheter (PICC), a client suddenly develops a high fever. The healthcare provider prescribes an immediate dose of intravenous ceftriaxone. What is the most appropriate action for the nurse to take?

  1. A
    Connect the antibiotic infusion as a secondary piggyback directly into the TPN tubing.
  2. B
    Pause the TPN, flush the PICC line with sterile normal saline, administer the antibiotic, and flush again.
  3. Insert a new peripheral intravenous catheter to administer the antibiotic.Answer
  4. D
    Increase the TPN infusion rate temporarily to complete the bag early, then administer the antibiotic.

Answer

The correct action is to establish a new, separate peripheral intravenous catheter for the administration of the antibiotic to maintain the dedicated TPN line.
Total parenteral nutrition (TPN) solutions contain high concentrations of dextrose, amino acids, and potentially lipids, making them highly incompatible with most medications. Additionally, the high glucose content makes the TPN line a prime site for bacterial growth. Evidence-based practice mandates that TPN must be infused through a dedicated line. Therefore, establishing a separate peripheral IV access is required to administer the prescribed antibiotic safely without interrupting or compromising the TPN line.

Step-by-Step Solution

1
Identify the current intravenous therapy and access.
The client has a single-lumen PICC line currently infusing TPN.
Assessing current access determines if it can be safely used for newly prescribed medications.
2
Evaluate the compatibility and safety guidelines for TPN administration.
TPN requires a strictly dedicated line and cannot be mixed or paused for other medications.
The high dextrose and amino acid content in TPN creates a high risk for drug precipitation and bacterial growth.
3
Determine the safest method to administer the newly prescribed intravenous antibiotic.
A new peripheral IV site must be established.
This preserves the dedicated TPN line while ensuring the client receives the necessary medication promptly.

Key Concept

Safe administration of total parenteral nutrition (TPN) requires a strictly dedicated intravenous line.
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Topics

Pharmacological and Parenteral Therapies

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