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Zorluk: ZorPharmacological and Parenteral Therapies

An intensive care nurse is caring for a hemodynamically unstable client who has a triple-lumen central venous catheter. The current continuous intravenous (IV) infusions are:

* Proximal port: Total parenteral nutrition (TPN)
* Medial port: 0.45% sodium chloride with 20 mEq/L of potassium chloride at 75 mL/hr
* Distal port: Propofol emulsion for continuous sedation

The client's mean arterial pressure abruptly drops to 54 mmHg. The healthcare provider prescribes an immediate 500 mL IV bolus of 0.9% sodium chloride and a continuous infusion of norepinephrine. Which action demonstrates the safest administration of these new prescriptions?

  1. A
    Y-site the 0.9% sodium chloride bolus and norepinephrine into the distal port to infuse concurrently with the propofol emulsion.
  2. B
    Attach the 0.9% sodium chloride bolus to the medial port and rapidly infuse it concurrently with the potassium chloride solution.
  3. Establish a new large-bore peripheral IV catheter to administer the fluid bolus and initiate the norepinephrine.Cevap
  4. D
    Temporarily pause the total parenteral nutrition on the proximal port, flush the line, and administer the fluid bolus and norepinephrine.

Cevap

Establish a new large-bore peripheral IV catheter to administer the fluid bolus and initiate the norepinephrine.
Establishing a new large-bore peripheral IV is the safest action. When all central venous catheter lumens are occupied by high-risk, dedicated (TPN, propofol), or incompatible (potassium) continuous infusions, the nurse must obtain new vascular access. Although norepinephrine is a vesicant that is ideally infused via a central line, current critical care emergency guidelines permit temporary administration through a large-bore peripheral IV to prevent fatal delays in life-saving treatment during shock.

Adım Adım Çözüm

1
Analyze the safety constraints of the current continuous infusions on the central venous catheter.
The proximal line (TPN) and distal line (propofol) strictly require dedicated access. The medial line contains potassium chloride.
Mixing medications with TPN or propofol increases infection and incompatibility risks.
2
Evaluate the physiological impact of rapidly bolusing fluid through the existing lumens.
Bolusing through the propofol line would rapidly push a sedative bolus into the client. Bolusing through the potassium line would deliver a fatal potassium bolus (speed shock).
Fluid boluses act as a rapid 'flush' for whatever medication is currently dwelling inside the IV tubing.
3
Determine the safest alternative access route for emergency resuscitation.
Establish a new large-bore peripheral IV to safely administer the fluids and temporary norepinephrine.
While central access is preferred for vasopressors, temporary peripheral administration is safe and indicated to prevent life-threatening delays during a hypotensive crisis when central lines are occupied.

Anahtar Kavram

IV Compatibility and Safe Administration of Parenteral Therapies during Emergencies
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Konular

Pharmacological and Parenteral Therapies

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