A client hospitalized with a massive pulmonary embolism is receiving a continuous intravenous infusion of unfractionated heparin through a single-lumen peripheral catheter. The client develops a systemic bloodstream infection, and the healthcare provider prescribes an intermittent intravenous infusion of vancomycin to run over 90 minutes. Upon consulting the facility's parenteral drug reference, the nurse notes that heparin and vancomycin are physically incompatible. Which action represents the safest nursing practice in this situation?
- Insert a second peripheral intravenous catheter to administer the vancomycin infusion.Cevap
- BPause the heparin infusion, thoroughly flush the line with 0.9% sodium chloride, infuse the vancomycin, flush the line again, and resume the heparin.
- CConnect the vancomycin secondary tubing to the lowest Y-site port and attach a 0.22-micron inline filter to trap any precipitates.
- DCalculate a new infusion rate to administer the vancomycin over 30 minutes, minimizing the interruption of the heparin infusion.
Cevap
The safest nursing action is to establish a second peripheral intravenous catheter to administer the vancomycin independently.
The safest approach when administering an incompatible prolonged intermittent infusion (such as a 90-minute vancomycin dose) to a client receiving a critical, short-acting continuous infusion (such as heparin for a pulmonary embolism) is to obtain a second intravenous access site. Heparin has a very short half-life (60 to 90 minutes). Pausing it for the duration of the vancomycin infusion would cause the client's activated partial thromboplastin time (aPTT) to drop well below the therapeutic range, dangerously increasing the risk of pulmonary embolism extension. Therefore, both medications must run concurrently through completely separate vascular access lines.
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Anahtar Kavram
Management of Intravenous Incompatibilities with High-Alert Continuous Infusions
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