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Difficulty: HardPharmacological and Parenteral Therapies

A client with acute decompensated heart failure is receiving a continuous intravenous (IV) infusion of milrinone through a dedicated 20-gauge peripheral catheter. The healthcare provider prescribes a STAT dose of furosemide 40 mg IV push. The client currently has no other venous access. Which action by the nurse is the safest and most appropriate?

  1. Establish a new peripheral IV catheter to administer the furosemide independently.Answer
  2. B
    Administer the furosemide via the Y-site closest to the client while the milrinone infuses.
  3. C
    Pause the milrinone, flush the line with 0.9% sodium chloride, administer the furosemide, and restart the milrinone.
  4. D
    Rapidly push the furosemide over 15 seconds through the primary line to minimize contact time between the medications.

Answer

Establish a new peripheral IV catheter to administer the furosemide independently.
Milrinone and furosemide are physically incompatible and will precipitate if mixed in the same IV line. Additionally, milrinone is a critical continuous inotropic infusion; the IV line cannot be paused and flushed. Flushing the line would push the milrinone residing in the tubing into the client as an uncontrolled, potentially fatal bolus, while simultaneously causing a dangerous drop in cardiac output during the pause. The only safe action is to establish a new, separate peripheral IV line for the furosemide.

Step-by-Step Solution

1
Analyze the properties of the continuous infusion.
Milrinone is a continuous inotropic/vasoactive medication used for severe heart failure that requires a dedicated line to maintain hemodynamic stability.
Understanding the high-alert nature of the primary infusion is critical before altering the line.
2
Evaluate the chemical compatibility of the prescribed medications.
Furosemide is highly incompatible with milrinone and will immediately precipitate if mixed in the same IV line.
Verifying IV compatibility prevents crystal formation and potential emboli.
3
Consider administration alternatives for the single IV line.
Pausing the milrinone disrupts critical cardiac support, and flushing the line delivers an uncontrolled, rapid bolus of the milrinone remaining in the tubing directly into the client's circulation.
Vasoactive continuous drips should never be flushed to clear a line for other medications.
4
Determine the safest clinical action.
Starting a new, independent peripheral IV line is required to safely administer the STAT dose of furosemide.
This is the only way to avoid precipitation and prevent a dangerous bolus of the inotropic agent.

Key Concept

IV Medication Compatibility and Vasoactive Infusion Safety
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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