A nurse is caring for a client who is receiving a continuous intravenous (IV) infusion of heparin for a deep vein thrombosis. The healthcare provider prescribes a scheduled dose of IV vancomycin to treat a concurrent wound infection. The client currently has a single-lumen peripheral IV catheter. When checking a drug reference guide, the nurse notes that heparin and vancomycin are chemically incompatible. Which action is the most appropriate for the nurse to take?
- AStop the heparin infusion, flush the line with normal saline, infuse the vancomycin over 60 minutes, and restart the heparin.
- Insert a second peripheral intravenous catheter to administer the vancomycin infusion.Answer
- CConnect the vancomycin tubing as a secondary piggyback into the port closest to the client on the heparin line.
- DRecalculate the vancomycin infusion rate to deliver the dose over 15 minutes to minimize the interruption of the heparin.
Answer
The most appropriate action is to insert a second peripheral intravenous catheter to administer the vancomycin.
Vancomycin and heparin are chemically incompatible and cannot be administered through the same IV tubing or Y-site. When a client requires a scheduled intermittent infusion (like vancomycin, which must run for at least 60 minutes) but is also receiving a critical continuous medication with a short half-life (like heparin), the continuous medication cannot be safely paused. Interrupting heparin for an hour would cause the client's activated partial thromboplastin time (aPTT) to drop below the therapeutic range, significantly increasing the risk of thrombus extension. Therefore, the safest and most appropriate nursing action is to establish a second peripheral IV access so both medications can be administered safely and effectively.
Step-by-Step Solution
Key Concept
Safe parenteral administration of incompatible continuous and intermittent medications.