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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is preparing to administer a prescribed intermittent intravenous (IV) infusion of amphotericin B deoxycholate. The medication is provided by the pharmacy in a 250 mL bag of 5% dextrose in water (D5W). The client currently has a single peripheral IV line with a continuous infusion of 0.9% sodium chloride (normal saline). Which of the following actions is most appropriate for the nurse to take?

  1. Pause the normal saline infusion, flush the IV line with D5W, infuse the amphotericin B, and flush the line again with D5W before restarting the normal saline.Answer
  2. B
    Attach the amphotericin B tubing to the Y-site of the running normal saline infusion to administer both fluids simultaneously.
  3. C
    Flush the IV line with 0.9% sodium chloride before and after the amphotericin B infusion to ensure the medication clears the tubing.
  4. D
    Program the IV infusion pump to deliver the entire dose of amphotericin B over 30 minutes to achieve peak therapeutic levels.

Answer

The nurse must pause the normal saline, flush the IV line with D5W, infuse the amphotericin B, and then flush again with D5W before restarting the normal saline.
Amphotericin B is highly incompatible with any solution containing sodium chloride. Contact between amphotericin B and normal saline will cause the medication to precipitate (crystallize), which can lead to catheter occlusion or an embolic event if the precipitate enters the bloodstream. Because the client has a continuous normal saline infusion running through a single IV access line, the nurse must completely clear the tubing of saline before the medication reaches it. This is safely achieved by pausing the saline, flushing the line with a chemically compatible solution (5% dextrose in water, or D5W), administering the medication, and then flushing again with D5W to ensure the line is entirely clear of the drug before restarting the normal saline.

Step-by-Step Solution

1
Verify IV fluid compatibility between the prescribed intermittent medication and the primary continuous IV fluids.
The nurse identifies that amphotericin B deoxycholate is strictly incompatible with 0.9% sodium chloride (normal saline).
Mixing incompatible fluids in the same IV tubing can cause precipitation, which can occlude the catheter or cause a life-threatening embolism.
2
Determine the appropriate flush solution and sequential administration protocol.
The nurse selects 5% dextrose in water (D5W) as the compatible flush solution because amphotericin B is chemically stable in dextrose.
Unlike most medications that use normal saline as a universal flush, amphotericin B requires D5W to prevent crystallization.
3
Execute the administration sequence.
The nurse pauses the normal saline, flushes with D5W, administers the medication, flushes again with D5W, and finally restarts the saline.
This specific sequence creates a 'barrier' of D5W that ensures the medication never physically contacts the incompatible normal saline in the tubing.

Key Concept

Amphotericin B is strictly incompatible with saline solutions and must be diluted, infused, and flushed exclusively with 5% dextrose in water (D5W).
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Topics

Pharmacological and Parenteral Therapies

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