An adult client being treated for severe sepsis has a double-lumen central venous catheter in place. One lumen is dedicated to a continuous infusion of total parenteral nutrition, and the other lumen is delivering a continuous infusion of norepinephrine. The provider prescribes an immediate intravenous dose of vancomycin. What is the safest action by the nurse?
- AConnect the vancomycin as a secondary infusion into the total parenteral nutrition line.
- BConnect the vancomycin as a secondary infusion into the norepinephrine line.
- Insert a new peripheral intravenous catheter to administer the vancomycin.Cevap
- DSuspend the norepinephrine infusion temporarily to allow the vancomycin to infuse.
Cevap
The nurse must insert a new peripheral intravenous catheter to administer the vancomycin, as both central line lumens are occupied by continuous therapies that cannot be interrupted or shared.
The correct action is to establish new peripheral intravenous access. The client has two critical continuous infusions running: total parenteral nutrition and norepinephrine. Total parenteral nutrition requires a strictly dedicated line due to a high infection risk and chemical incompatibilities. Norepinephrine is a life-sustaining vasopressor; adding a secondary piggyback into its line alters the delivery rate of the vasopressor, potentially causing a dangerous bolus effect or diluting the medication. Additionally, pausing the vasopressor would lead to rapid and profound hypotension. Therefore, neither existing lumen can be safely used, and new access is required.
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Anahtar Kavram
Continuous critical infusions such as total parenteral nutrition and vasopressors require dedicated intravenous access and should not be interrupted or used for secondary medication administration.