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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is preparing to administer an intravenous (IV) push dose of furosemide to a client who is receiving a continuous IV infusion of amiodarone. The client has only one patent peripheral IV line. Amiodarone and furosemide are physically incompatible. Arrange the following steps for safely administering the IV push medication in the correct sequential order.

  1. 1Stop the continuous amiodarone infusion pump.
  2. 2Clamp the primary IV tubing above the lowest injection port.
  3. 3Scrub the injection port and flush the line with 10 mL of 0.9% sodium chloride.
  4. 4Administer the IV push furosemide over 1 to 2 minutes.
  5. 5Flush the line with 10 mL of 0.9% sodium chloride at the same rate as the medication administration.
  6. 6Unclamp the primary tubing and restart the continuous amiodarone infusion.

Answer

The correct sequence is to stop the infusion pump, clamp the primary tubing, flush with normal saline, administer the furosemide, flush again with normal saline at the same slow rate as the medication, and finally unclamp and restart the pump.
When administering an IV push medication through a single patent line with an incompatible continuous infusion, the nurse must meticulously prevent the two medications from mixing to avoid precipitation. The process involves stopping the current infusion and clamping the tubing to isolate the lower port. A normal saline flush creates a liquid buffer, clearing the primary medication from the distal tubing. The secondary medication is then pushed at the correct rate. The second saline flush must be administered at the exact same rate as the medication to ensure the drug remaining in the dead space of the IV catheter is not accidentally bolused. Once the line is clear, the tubing is unclamped and the primary infusion is restarted.

Step-by-Step Solution

1
Stop the amiodarone infusion pump.
The flow of the incompatible medication is halted.
This is the first essential step to prevent the two incompatible medications from coming into contact with each other.
2
Clamp the primary IV tubing above the lowest injection port.
The pathway back up the primary IV tubing is blocked.
Clamping ensures that subsequent flushes and the IV push medication travel directly into the patient's vein rather than backing up into the primary line.
3
Scrub the injection port and flush the line with 10 mL of 0.9% sodium chloride.
The lower segment of the IV tubing and the catheter hub are cleared of amiodarone.
Normal saline acts as a safe, compatible buffer between the two incompatible medications.
4
Administer the IV push furosemide over 1 to 2 minutes.
The diuretic is safely delivered into the cleared IV line.
Administering the medication over the recommended duration prevents adverse effects such as ototoxicity.
5
Flush the line with 10 mL of 0.9% sodium chloride at the same rate as the medication administration.
The medication remaining in the catheter hub is fully delivered to the patient.
Flushing at the same slow rate prevents a sudden bolus (speed shock) of the residual furosemide.
6
Unclamp the primary tubing and restart the continuous amiodarone infusion.
The continuous antiarrhythmic infusion is resumed.
With the line completely cleared of the incompatible furosemide, it is safe to restart the amiodarone.

Key Concept

Safe administration of an IV push medication into a continuous infusion of a physically incompatible medication requires stopping the infusion, clamping the line, and utilizing normal saline flushes to create a buffer, taking care to administer the post-medication flush at the same rate as the IV push drug.
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Topics

Pharmacological and Parenteral Therapies

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