Examkin

Soru

Zorluk: Çok zorPharmacological and Parenteral Therapies

A client with acute decompensated heart failure is receiving continuous intravenous (IV) infusions of milrinone at 0.5 mcg/kg/min0.5 \text{ mcg/kg/min} and heparin at 1,200 units/hr1,200 \text{ units/hr} through a double-lumen central venous catheter (CVC). The client's morning serum potassium level is 2.6 mEq/L2.6 \text{ mEq/L}. The healthcare provider prescribes a single dose of potassium chloride (KCl) 40 mEq40 \text{ mEq} in 100 mL100 \text{ mL} of 0.9%0.9\% sodium chloride to infuse intravenously over 4 hours4 \text{ hours}. The nurse consults a parenteral drug reference and notes that KCl is physically incompatible with both milrinone and heparin at the Y-site. Which action is the most appropriate for the nurse to take?

  1. A
    Pause the continuous heparin infusion for the duration of the KCl administration, as correcting severe hypokalemia takes clinical priority over maintaining anticoagulation.
  2. B
    Establish a new peripheral intravenous catheter and administer the prescribed KCl solution using an electronic volumetric infusion pump.
  3. C
    Administer the KCl solution concurrently with the milrinone infusion via the CVC, utilizing a 0.22-micron0.22\text{-micron} in-line filter to prevent the infusion of chemical precipitates.
  4. Contact the healthcare provider to discuss alternative central venous access or an enteral route, as the prescribed KCl concentration is unsafe for peripheral administration.Cevap

Cevap

Contact the healthcare provider to discuss alternative central venous access or an enteral route, as the prescribed KCl concentration is unsafe for peripheral administration.
The prescribed KCl concentration (40 mEq40 \text{ mEq} in 100 mL100 \text{ mL}, or 0.4 mEq/mL0.4 \text{ mEq/mL}) significantly exceeds the maximum safe concentration for peripheral IV administration, which is typically 10 mEq10 \text{ mEq} per 100 mL100 \text{ mL} (0.1 mEq/mL0.1 \text{ mEq/mL}). Administering this concentration peripherally poses a severe risk of phlebitis and tissue necrosis. Because the existing central line is fully occupied by critical, continuous infusions (milrinone for cardiac output and heparin for anticoagulation) that are incompatible with KCl and cannot be safely paused, the nurse is unable to safely administer the medication as ordered. The only safe action is to contact the provider to establish new central access, dilute the medication further (if fluid status permits), or change to an enteral route.

Adım Adım Çözüm

1
Analyze the prescribed KCl concentration and determine safe administration routes.
The concentration is 40 mEq40 \text{ mEq} in 100 mL100 \text{ mL} (0.4 mEq/mL0.4 \text{ mEq/mL}). This exceeds the maximum peripheral limit (0.1 mEq/mL0.1 \text{ mEq/mL}) and absolutely requires central venous administration.
High concentrations of potassium chloride are hyperosmolar and highly irritating, causing severe chemical phlebitis if given via a peripheral vein.
2
Assess the availability of the current central venous access.
Both lumens of the CVC are occupied by milrinone (a critical inotrope for heart failure) and heparin (a critical anticoagulant).
Incompatible medications cannot share the same IV lumen due to the risk of precipitate formation and drug inactivation.
3
Evaluate if the continuous infusions can be safely interrupted.
Neither infusion can be paused. Milrinone is life-sustaining for cardiac output, and pausing heparin for 4 hours4 \text{ hours} (well past its 1-2 hour half-life) risks severe thrombosis.
Nursing prioritization requires maintaining hemodynamic and hematologic stability; critical continuous drips should never be paused for routine electrolyte replacement.
4
Determine the necessary nursing intervention.
The nurse must withhold the medication and contact the healthcare provider to request a safe alternative.
Safe administration requires either placing a new central line, ordering a larger volume dilution safe for a new peripheral IV (if fluid restriction allows), or utilizing the enteral route.

Anahtar Kavram

IV Medication Safety: Maximum Peripheral Potassium Concentrations and Management of Incompatible Continuous Infusions
Bu soruyu puanla

Konular

Pharmacological and Parenteral Therapies

Bu konudan daha fazla soru