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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer a prescribed intravenous (IV) push medication through a client's central venous catheter (CVC). The specific lumen to be used is currently capped and locked with a heparin solution. Place the following steps for administering the medication in the correct chronological order.

  1. 1Scrub the needleless connector with an antiseptic swab and allow it to dry completely.
  2. 2Attach a syringe with normal saline, aspirate for a blood return, and flush the lumen.
  3. 3Attach the medication syringe and administer the IV push medication at the prescribed rate.
  4. 4Attach a new syringe with normal saline and flush the lumen at the same rate as the medication.
  5. 5Instill the prescribed amount of heparin flush solution to lock the lumen.

Answer

The correct sequence follows the standard SASH protocol: Scrub the hub, flush with Saline (after aspirating), Administer the medication, flush with Saline again, and finally lock with Heparin.
The SASH (Saline, Administer, Saline, Heparin) method is the evidence-based standard of practice for administering medications through a capped central venous catheter. This sequence ensures infection control, confirms line patency, prevents drug incompatibilities, and maintains the line for future use.

Step-by-Step Solution

1
Scrub the needleless connector.
Disinfects the access point.
Prevents Central Line-Associated Bloodstream Infections (CLABSI).
2
Aspirate for blood and flush with normal saline.
Confirms placement and clears the heparin lock.
Ensures the catheter is in the vein and patent, and prevents incompatibility between heparin and the incoming medication.
3
Administer the IV push medication.
Delivers the prescribed therapy.
Provides the required pharmacological treatment at a safe, controlled rate.
4
Flush with normal saline at the medication's administration rate.
Clears the medication from the catheter.
Ensures the full dose reaches the patient without inadvertently bolusing the residual medication left in the line.
5
Instill the heparin flush solution.
Locks the catheter lumen.
Maintains catheter patency and prevents blood clots from forming while the line is capped.

Key Concept

Central Venous Catheter Medication Administration (SASH Protocol)
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Topics

Pharmacological and Parenteral Therapies

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