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Zorluk: ZorPharmacological and Parenteral Therapies

A client with septic shock is receiving a continuous intravenous (IV) infusion of norepinephrine through a single-lumen peripherally inserted central catheter (PICC). The client's current mean arterial pressure (MAP) is 60 mmHg60\text{ mmHg}. The healthcare provider prescribes a stat IV dose of sodium bicarbonate to treat severe metabolic acidosis. No other IV access is currently established. Which of the following actions by the nurse is the most appropriate?

  1. Establish a second peripheral intravenous access site prior to administering the sodium bicarbonate.Cevap
  2. B
    Connect the sodium bicarbonate to the lowest Y-site port on the primary norepinephrine IV tubing.
  3. C
    Pause the norepinephrine infusion, flush the line with 0.9% sodium chloride, administer the prescribed dose, and flush again.
  4. D
    Administer the sodium bicarbonate concurrently as a slow intravenous push through the continuous norepinephrine line.

Cevap

Establish a second peripheral intravenous access site prior to administering the sodium bicarbonate.
The correct action recognizes two critical safety principles: first, life-sustaining vasopressors like norepinephrine cannot be paused in hemodynamically unstable clients; second, catecholamines are inactivated by alkaline solutions like sodium bicarbonate. Establishing a new IV access is the only way to safely administer both.

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1
Analyze the client's hemodynamic status and current continuous infusions.
The client has a MAP of 60 mmHg and relies on a continuous norepinephrine infusion to maintain perfusion.
Understanding the critical nature of the continuous infusion dictates whether it can be safely interrupted.
2
Determine the chemical compatibility of the prescribed medications.
Sodium bicarbonate (alkaline) and norepinephrine (catecholamine) are chemically incompatible.
Mixing incompatible medications can lead to precipitation or drug inactivation.
3
Evaluate the feasibility of using the existing single-lumen PICC.
The PICC cannot be used for the sodium bicarbonate because the norepinephrine cannot be paused, and the two drugs cannot mix.
Pausing the vasopressor causes immediate hypotension, and mixing them destroys the vasopressor.
4
Select the intervention that safely delivers both medications.
A new peripheral IV line must be inserted.
This allows uninterrupted delivery of the life-saving vasopressor while independently treating the metabolic acidosis.

Anahtar Kavram

Management of incompatible parenteral therapies and life-sustaining continuous infusions.
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Konular

Pharmacological and Parenteral Therapies

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