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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a client with hypovolemic shock who is receiving a rapid, continuous intravenous infusion of Lactated Ringer's solution through a single large-bore peripheral catheter. The healthcare provider prescribes a stat unit of packed red blood cells (PRBCs). Which of the following is the safest nursing action for administering the blood product?

  1. Establish a second intravenous access site to administer the packed red blood cells with 0.9% sodium chloride.Answer
  2. B
    Attach the blood administration set to the lowest Y-site port of the continuous Lactated Ringer's infusion.
  3. C
    Flush the existing intravenous catheter with 5% Dextrose in Water (D5W) prior to infusing the packed red blood cells.
  4. D
    Pause the Lactated Ringer's infusion to administer the blood product, prioritizing oxygen delivery over fluid volume.

Answer

Establish a second intravenous access site to administer the packed red blood cells with 0.9% sodium chloride.
The correct answer emphasizes that packed red blood cells can only be administered with 0.9% sodium chloride. Because the client is in hypovolemic shock, continuous volume resuscitation with the prescribed Lactated Ringer's is also critical. Therefore, establishing a second large-bore intravenous access site allows both the life-saving blood product and the continuous fluid replacement to infuse simultaneously and safely without risk of incompatibility.

Step-by-Step Solution

1
Identify the primary medical emergency and the prescribed therapies.
The client is in hypovolemic shock, requiring continuous Lactated Ringer's for volume expansion and packed red blood cells for oxygen-carrying capacity.
Understanding the clinical context is essential for prioritizing interventions.
2
Evaluate the physical compatibility of the prescribed intravenous therapies.
Packed red blood cells are incompatible with Lactated Ringer's due to its calcium content, and they are also incompatible with dextrose solutions.
Administering blood with incompatible solutions leads to dangerous clotting or hemolysis.
3
Determine the safest method to deliver all necessary therapies without delay.
Establishing a second intravenous access line allows both the Lactated Ringer's and the packed red blood cells (primed with 0.9% sodium chloride) to infuse concurrently.
This prevents adverse infusion reactions while aggressively treating the hypovolemic shock.

Key Concept

Intravenous Compatibility and Blood Administration Safety
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Topics

Pharmacological and Parenteral Therapies

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