Examkin

Question

Difficulty: MediumPharmacological and Parenteral Therapies

A client admitted with a severe bacterial infection has a single peripheral intravenous (IV) catheter in the left forearm. A continuous infusion of Lactated Ringer's is currently running at 100 mL/hr100\text{ mL/hr}. The healthcare provider prescribes a stat dose of intravenous ceftriaxone 1 g1\text{ g} mixed in 50 mL50\text{ mL} of 0.9%0.9\% sodium chloride, to be infused over 30 minutes30\text{ minutes}. Which of the following is the most appropriate action by the nurse?

  1. Stop the continuous infusion, flush the line thoroughly with 0.9% sodium chloride, infuse the antibiotic, and flush the line again before restarting.Answer
  2. B
    Attach the antibiotic tubing as a secondary piggyback to the port closest to the client while the primary continuous infusion continues to run.
  3. C
    Request the pharmacy to reconstitute the antibiotic in a bag of Lactated Ringer's to match the client's current continuous intravenous fluids.
  4. D
    Wait until the current bag of Lactated Ringer's is completely infused before administering the scheduled dose of the antibiotic.

Answer

The primary continuous infusion of Lactated Ringer's must be stopped, and the IV line must be flushed with 0.9% sodium chloride before and after the ceftriaxone administration.
Ceftriaxone binds with calcium to form fatal precipitates. Because Lactated Ringer's contains calcium, the two must never mix in the IV line. Stopping the infusion and flushing the line with 0.9% sodium chloride (normal saline) before and after the ceftriaxone dose completely clears the tubing of calcium, allowing safe administration through a single IV site.

Step-by-Step Solution

1
Analyze the prescribed medications and the client's current continuous IV fluids.
The client is receiving Lactated Ringer's continuously, and ceftriaxone is prescribed to be administered via the same line.
Identifying all substances that will pass through a single IV access site is the first step in ensuring medication safety.
2
Evaluate the physical compatibility between ceftriaxone and Lactated Ringer's.
Ceftriaxone is strictly incompatible with any calcium-containing solutions, including Lactated Ringer's, because they form crystalline precipitates.
Preventing the administration of incompatible IV solutions is critical to avoid life-threatening emboli.
3
Determine the safest method of administration given the single peripheral IV access.
The nurse must stop the Lactated Ringer's, flush the line with a compatible fluid (0.9% sodium chloride), administer the antibiotic, and flush again before resuming the fluids.
This 'sandwich' method ensures that the incompatible solutions never come into contact within the IV tubing.

Key Concept

Intravenous Compatibility and Calcium-Ceftriaxone Precipitation
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic