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Zorluk: OrtaPharmacological and Parenteral Therapies

An adult client is admitted to the gastroenterology unit and requires continuous total parenteral nutrition (TPN). The TPN is infusing through a single-lumen peripherally inserted central catheter (PICC). The client has a new prescription for a scheduled intravenous (IV) dose of pantoprazole. Which action should the nurse take to safely administer the medication?

  1. Establish a new peripheral intravenous access site to administer the prescribed pantoprazoleCevap
  2. B
    Connect the pantoprazole tubing as a secondary infusion to the lowest Y-site port on the TPN line
  3. C
    Stop the TPN infusion temporarily, flush the PICC line with 0.9% sodium chloride, and administer the medication
  4. D
    Pause the TPN during the medication administration, then increase the TPN infusion rate to catch up on the missed volume

Cevap

The correct action is to establish a new peripheral intravenous access site to administer the prescribed pantoprazole.
Total parenteral nutrition (TPN) is a complex, highly concentrated solution that requires a dedicated intravenous line due to the high risk of chemical incompatibility and precipitation with other medications. Additionally, the high glucose content of TPN makes the line highly susceptible to bacterial and fungal infections. Because the client has a single-lumen PICC currently dedicated to the TPN, the nurse cannot use this line for any other infusions or medications. The safest and only appropriate action is to establish a separate peripheral intravenous site for the administration of the pantoprazole.

Adım Adım Çözüm

1
Identify the client's current intravenous access and existing continuous infusions.
The client has a single-lumen PICC that is actively being used for a continuous TPN infusion.
Recognizing the type of line and current infusion is necessary to evaluate if the site can be safely used for additional medications.
2
Evaluate the compatibility and safety guidelines for administering medications alongside TPN.
Evidence-based practice dictates that TPN must always have a dedicated intravenous line or a dedicated lumen in a multi-lumen central catheter.
TPN has a high risk of chemical incompatibility with most medications and poses a high risk for infection due to its concentrated glucose and lipid content.
3
Determine the safest method to administer the newly prescribed intravenous medication.
The nurse must start a new peripheral intravenous catheter for the pantoprazole.
Since the current single-lumen PICC is occupied by TPN and cannot be shared, piggybacked into, or safely interrupted, a secondary access site is clinically required.

Anahtar Kavram

Total Parenteral Nutrition (TPN) Safe Administration and Dedicated Line Protocol
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Konular

Pharmacological and Parenteral Therapies

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