A nurse is caring for a client with a deep vein thrombosis who is receiving a continuous intravenous (IV) infusion of heparin via a single-lumen peripherally inserted central catheter (PICC). The client suddenly reports severe nausea and vomits dark, coffee-ground emesis. The client's most recent activated partial thromboplastin time (aPTT) is . The healthcare provider prescribes a stat dose of IV pantoprazole . Which sequence of actions is the most appropriate for the nurse to perform?
- APause the heparin infusion, flush the PICC with of , administer the pantoprazole, and then resume the heparin at a reduced rate.
- BMaintain the heparin infusion to prevent thrombus extension, immediately establish a peripheral IV line to administer the pantoprazole, and notify the provider.
- Immediately stop the heparin infusion, aspirate residual medication from the PICC lumen, flush with of , and administer the pantoprazole.Cevap
- DStop the heparin infusion, administer the pantoprazole into the lowest Y-site of the primary IV tubing, and flush with of .
Cevap
The nurse must immediately stop the heparin, aspirate the PICC to remove residual drug, flush with normal saline, and then administer the pantoprazole.
The client is presenting with active gastrointestinal bleeding and a critically supratherapeutic aPTT of (therapeutic is typically ). The highest priority is to immediately discontinue the heparin infusion to prevent further hemorrhage. Because a PICC lumen contains dead space filled with the heparin solution, the nurse must aspirate the residual medication; flushing without aspirating would inadvertently administer a bolus of the concentrated anticoagulant directly into the client's circulation. Finally, pantoprazole is chemically incompatible with heparin and requires a thoroughly flushed line () before administration to prevent drug precipitation.
Adım Adım Çözüm
Anahtar Kavram
Management of life-threatening adverse medication reactions and central line compatibility protocols.