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Zorluk: ZorPharmacological and Parenteral Therapies

A nurse is caring for a client with a serum potassium level of 2.6 mEq/L2.6 \text{ mEq/L}. The provider prescribes 20 mEq20 \text{ mEq} of intravenous potassium chloride (KCl) diluted in 100 mL100 \text{ mL} of 0.9%0.9\% normal saline to be infused over 1 hour1 \text{ hour}. The client has a 22-gauge peripheral IV in the right forearm and a double-lumen peripherally inserted central catheter (PICC) in the left arm. Which of the following is the most appropriate action by the nurse?

  1. Administer the infusion via the PICC line using an electronic infusion pump.Cevap
  2. B
    Administer the infusion via the peripheral IV using an electronic infusion pump.
  3. C
    Request that the pharmacy dilute the 20 mEq20 \text{ mEq} of KCl into 500 mL500 \text{ mL} of normal saline to infuse over 1 hour1 \text{ hour} via the peripheral IV.
  4. D
    Withhold the medication and question the prescription because 20 mEq/hr20 \text{ mEq/hr} exceeds the maximum safe administration rate for any intravenous route.

Cevap

The nurse should administer the infusion via the PICC line using an electronic infusion pump.
The prescription calls for a rate of 20 mEq/hr and a concentration of 20 mEq/100 mL. Both of these values exceed the standard safety limits for peripheral intravenous administration (maximum 10 mEq/hr and 10 mEq/100 mL). Because the client has a peripherally inserted central catheter (PICC), the nurse can safely administer this higher rate and concentration centrally. Intravenous potassium must always be administered using an electronic infusion pump to prevent rapid infusion and subsequent cardiac arrest.

Adım Adım Çözüm

1
Analyze the prescribed medication dose, concentration, and administration rate.
The prescription is for 20 mEq of KCl in 100 mL to be given over 1 hour. The hourly rate is 20 mEq/hr and the concentration is 20 mEq/100 mL.
Intravenous potassium chloride is a high-alert medication with strict limits on rate and concentration to prevent fatal cardiac dysrhythmias and severe vein damage.
2
Compare the prescribed parameters to safe administration limits for peripheral versus central lines.
Peripheral IV limits are generally a maximum of 10 mEq/hr and 10 mEq/100 mL. Central line limits safely allow up to 20 mEq/hr (and higher in critical care with continuous monitoring).
Determining the correct route ensures patient safety and prevents medication errors related to route of administration.
3
Select the appropriate route and equipment based on the available venous access and safety guidelines.
The PICC line must be used because both the rate and concentration exceed peripheral safety thresholds. An electronic infusion pump must always be used.
Central lines deposit irritating medications into larger, high-flow vessels, preventing phlebitis. Electronic infusion pumps prevent accidental free-flow.

Anahtar Kavram

Intravenous Potassium Chloride (KCl) Administration Safety
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Konular

Pharmacological and Parenteral Therapies

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