An adult client hospitalized with a deep vein thrombosis is receiving a continuous intravenous infusion of heparin. The healthcare provider prescribes a scheduled dose of intravenous vancomycin to treat a concurrent wound infection. The client currently has a single patent -gauge peripheral venous catheter. Upon checking the facility drug reference, the nurse notes that heparin and vancomycin are physically incompatible at the Y-site. Which action by the nurse is the most appropriate?
- Insert a second peripheral intravenous catheter to administer the vancomycin infusion.Answer
- BTemporarily halt the continuous heparin drip, clear the line with sterile normal saline, and infuse the vancomycin.
- CAttach the vancomycin tubing directly to the primary line to allow simultaneous delivery of both medications.
- DRecalculate the continuous heparin delivery rate to compensate for the additional fluid volume from the antibiotic.
Answer
The nurse should insert a second peripheral intravenous catheter to administer the vancomycin infusion.
The correct action is to establish a second peripheral intravenous site. Because heparin and vancomycin are physically incompatible, they cannot be mixed in the same line without risking precipitation. Additionally, heparin is a critical continuous infusion with a short half-life; stopping it for the duration of a vancomycin infusion (typically to minutes) would cause subtherapeutic anticoagulation levels, placing the client at high risk for clot extension.
Step-by-Step Solution
Key Concept
Safe administration of incompatible intravenous medications and management of continuous high-alert infusions