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Zorluk: Çok zorPharmacological and Parenteral Therapies

A client with a systemic fungal infection has a double-lumen peripherally inserted central catheter (PICC). The proximal lumen is dedicated to a continuous total parenteral nutrition (TPN) infusion. The distal lumen is infusing 0.9% sodium chloride with 20 mEq of potassium chloride at 75 mL/hr. The healthcare provider prescribes a daily intermittent intravenous (IV) infusion of amphotericin B deoxycholate. Which of the following actions by the nurse demonstrates the correct technique for administering this medication?

  1. Pause the saline and potassium infusion, flush the distal lumen with 5% dextrose in water (D5W), administer the amphotericin B, and flush again with D5W.Cevap
  2. B
    Pause the saline and potassium infusion, flush the distal lumen with 0.9% sodium chloride, administer the amphotericin B, and flush again with 0.9% sodium chloride.
  3. C
    Connect the amphotericin B as a secondary piggyback into the distal lumen's Y-site to infuse concurrently with the saline and potassium solution.
  4. D
    Temporarily halt the total parenteral nutrition (TPN), administer the amphotericin B through the proximal lumen, and subsequently increase the TPN rate to compensate for the paused time.

Cevap

The correct approach is to pause the incompatible saline and potassium infusion, flush the line thoroughly with 5% dextrose in water (D5W), administer the amphotericin B, and then flush again with D5W before restarting the primary fluids.
The correct action demonstrates advanced pharmacological knowledge of high-risk parenteral therapies. Because the TPN line must remain dedicated, the nurse must use the distal lumen. Since amphotericin B precipitates when mixed with normal saline or electrolytes (potassium), the nurse must pause the primary infusion and clear the line completely using 5% dextrose in water (D5W), which is the only compatible flush solution for this medication.

Adım Adım Çözüm

1
Analyze the current IV infusions and line access.
The client has a double-lumen PICC. One lumen has TPN, the other has normal saline with potassium chloride.
Establishing what access is available is the first step in safe parenteral medication administration.
2
Determine the compatibility of amphotericin B with the existing continuous infusions.
Amphotericin B is highly incompatible with both TPN and 0.9% sodium chloride (normal saline).
Amphotericin B precipitates in the presence of electrolytes and saline, posing a severe risk to the client if mixed.
3
Select the appropriate lumen for administration.
The distal lumen must be used.
The proximal lumen contains TPN, which must remain a dedicated line and cannot be interrupted or used for secondary medications.
4
Determine the correct flush protocol for the selected lumen.
The primary saline infusion must be paused, and the line must be flushed with 5% dextrose in water (D5W) before and after the amphotericin B infusion.
D5W is the only compatible solution for flushing and diluting amphotericin B. Using the standard normal saline flush will cause immediate medication precipitation in the catheter.

Anahtar Kavram

Amphotericin B Parenteral Compatibility and Dedicated IV Line Management
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Konular

Pharmacological and Parenteral Therapies

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