Examkin

Question

Difficulty: Very hardPharmacological and Parenteral Therapies

A nurse is caring for a client with acute decompensated heart failure and atrial fibrillation. The client has a double-lumen central venous catheter (CVC) with the following continuous infusions:

* Lumen 1: Dobutamine at 10 mcg/kg/min10 \text{ mcg/kg/min}
* Lumen 2: Heparin at 1,200 units/hr1,200 \text{ units/hr}

The client develops sudden, severe dyspnea and crackles bilaterally. The provider prescribes furosemide 40 mg40 \text{ mg} IV push STAT. The client does not have peripheral intravenous access. Which action by the nurse is the most appropriate method to administer the furosemide?

  1. A
    Pause the dobutamine infusion, flush Lumen 1 with 0.9%0.9\% sodium chloride, administer the furosemide, flush again, and resume the dobutamine
  2. Pause the heparin infusion, flush Lumen 2 with 0.9%0.9\% sodium chloride, administer the furosemide, flush again, and resume the heparinAnswer
  3. C
    Administer the furosemide via the Y-site of Lumen 1 without pausing the dobutamine infusion
  4. D
    Administer the furosemide via the Y-site of Lumen 2 without pausing the heparin infusion

Answer

The most appropriate action is to pause the heparin infusion, flush the lumen with 0.9% sodium chloride, administer the furosemide, flush again, and resume the heparin.
Heparin is a non-vasoactive continuous infusion with a relatively long half-life (60-90 minutes). Pausing it briefly (3-5 minutes) to flush the line, administer a STAT, incompatible medication like furosemide, and flush again is standard and safe critical care practice. This utilizes the available access without compromising hemodynamic stability.

Step-by-Step Solution

1
Identify the constraints of the scenario
The furosemide must be administered through one of the two existing central line lumens.
The client lacks peripheral IV access and the medication is a STAT priority.
2
Evaluate Lumen 1 (Dobutamine) for safety
Lumen 1 cannot be used for the IV push.
Pushing medication into a vasoactive line inadvertently boluses the vasoactive drug into the client. Additionally, pausing a short-acting life-sustaining inotrope causes rapid hemodynamic collapse.
3
Evaluate Lumen 2 (Heparin) for safety and compatibility
Heparin and furosemide are physically incompatible, meaning they cannot mix in the tubing.
Furosemide will immediately precipitate if administered via the Y-site of a running heparin infusion.
4
Determine the safest administration sequence
Pause heparin, flush the line, push furosemide, flush the line, and restart heparin.
Heparin has a 60-90 minute half-life; a 3-5 minute pause will not harm the client. Flushing the line before and after completely prevents the incompatible furosemide and heparin from mixing.

Key Concept

Safe administration of IV push medications via central lines with vasoactive and incompatible continuous infusions.
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic