Examkin

Soru

Zorluk: ZorPharmacological and Parenteral Therapies

A client is receiving a continuous intravenous (IV) infusion of unfractionated heparin. The nurse must administer a scheduled dose of an IV push medication that is chemically incompatible with heparin. The client has a single peripheral IV access line. Arrange the following actions in the correct sequence to safely administer the medication.

  1. 1Stop the continuous intravenous infusion pump.
  2. 2Clamp the primary tubing, aspirate for a blood return, and flush the lowest injection port with 10 mL of 0.9% sodium chloride.
  3. 3Administer the intravenous push medication at the prescribed rate.
  4. 4Flush the injection port with 10 mL of 0.9% sodium chloride at the same rate the medication was administered.
  5. 5Unclamp the primary tubing and restart the continuous intravenous infusion.

Cevap

The correct sequence is to first stop the continuous infusion pump, then clamp the tubing above the lowest port and flush with normal saline, followed by administering the IV push medication. After administration, flush again with normal saline at the same rate the medication was given, and finally unclamp and restart the continuous infusion.
When administering an IV push medication through a single peripheral line with an incompatible continuous infusion, the nurse must first stop the pump to halt the primary fluid. The tubing must be clamped immediately above the lowest injection port (closest to the client) to prevent retrograde flow. A pre-flush of normal saline clears the line of the incompatible drug to avoid precipitation. The medication is then administered at the prescribed rate. Crucially, the post-flush must also be administered at the exact same slow rate as the medication because the lower tubing still contains the active drug. Rapid flushing would push the residual drug into the client too quickly, risking speed shock. Finally, the tubing is unclamped and the continuous infusion is restarted.

Adım Adım Çözüm

1
Stop the continuous heparin infusion.
The flow of the incompatible medication is temporarily halted.
This prevents the incompatible medications from mixing in the line during the procedure.
2
Clamp the primary tubing and flush the lowest injection port with normal saline.
The line below the port and the IV catheter are cleared of heparin.
Clamping prevents the flush from traveling retrogradely up the line. Flushing clears the physical space of the incompatible drug to prevent dangerous precipitation.
3
Administer the IV push medication.
The medication is delivered into the cleared IV line.
The medication is given at the prescribed rate to ensure safety and therapeutic effect.
4
Flush the line with normal saline at the same rate the medication was administered.
The remaining medication in the dead space of the IV tubing and catheter is safely delivered.
Flushing too quickly would result in rapid bolus delivery (speed shock) of the residual medication still present in the tubing.
5
Unclamp the tubing and restart the continuous infusion.
The primary heparin infusion resumes.
This restores the continuous therapeutic delivery of the primary medication.

Anahtar Kavram

Safe administration of an IV push medication through a line with an incompatible continuous infusion requires isolating the injection site, adequately clearing the line before and after administration, and carefully controlling flush rates to prevent speed shock.
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Pharmacological and Parenteral Therapies

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