A client diagnosed with severe sepsis has a double-lumen central venous catheter (CVC). The proximal lumen is dedicated to a continuous infusion of total parenteral nutrition (TPN). The distal lumen is delivering a continuous infusion of norepinephrine to maintain systemic vascular resistance. During the shift, the client's mean arterial pressure drops to . The provider verbally prescribes an immediate intravenous bolus of lactated Ringer's solution and of hydrocortisone sodium succinate via intravenous push. Which action by the nurse demonstrates the safest administration of these prescribed therapies?
- Establish a new peripheral intravenous catheter to administer the fluid bolus and the intravenous push medication.Cevap
- BPause the total parenteral nutrition infusion, flush the proximal lumen with sterile saline, and administer the prescribed therapies.
- CConnect the fluid bolus to the distal lumen and infuse it concurrently with the continuous norepinephrine.
- DTemporarily pause the norepinephrine, administer the hydrocortisone via the distal lumen, flush the line, and resume the infusion.
Cevap
Establish a new peripheral intravenous catheter to administer the fluid bolus and the intravenous push medication.
The correct answer is to establish a new peripheral intravenous catheter. When managing a critically ill client with a multi-lumen central line, the nurse must adhere to strict parenteral safety rules regardless of the emergency. The proximal lumen is infusing total parenteral nutrition (TPN), which requires a strictly dedicated line; it must never be used for fluid boluses, blood products, or intravenous push medications due to the high risk of infection and chemical incompatibility. The distal lumen is infusing norepinephrine, a potent continuous vasopressor. Connecting a rapid fluid bolus to this line, or flushing the line to administer an intravenous push medication, will rapidly flush the residual norepinephrine residing in the intravenous tubing's dead space directly into the client's central circulation. This unintentional bolus can cause a lethal hypertensive crisis and fatal arrhythmias. Additionally, temporarily pausing the norepinephrine in a severely hypotensive client (MAP of 54 mm Hg) will cause immediate cardiovascular collapse. Therefore, the only safe action is to rapidly establish a new peripheral intravenous access site for the new prescriptions.
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Anahtar Kavram
Central line lumen dedication, vasopressor administration safety, and the prevention of unintended medication boluses (speed shock).