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Zorluk: ZorPharmacological and Parenteral Therapies

During a shift in the cardiac care unit, a nurse evaluates a client experiencing severe pulmonary edema secondary to cardiogenic shock. The client is currently receiving a continuous dobutamine infusion via their only patent peripheral intravenous (IV) catheter. A new stat prescription for intravenous furosemide is received. Which of the following actions must the nurse perform to safely administer the medication?

  1. Initiate a new peripheral intravenous catheter to administer the furosemide.Cevap
  2. B
    Attach the furosemide syringe to the lowest Y-site port on the primary infusion tubing.
  3. C
    Halt the dobutamine infusion briefly to flush the line and push the furosemide.
  4. D
    Request the healthcare provider to change the furosemide prescription to an intramuscular injection.

Cevap

The nurse must initiate a new peripheral intravenous catheter to administer the furosemide, preventing drug precipitation and avoiding the interruption of life-sustaining inotropic support.
Establishing a separate intravenous line is the only safe approach. Furosemide is highly alkaline, whereas dobutamine is acidic. Administering them together in the same line will cause immediate physical precipitation. Furthermore, dobutamine is an essential inotropic agent with a very short half-life. Pausing the infusion, even briefly to flush and push another drug, can result in rapid and profound hemodynamic deterioration in a client with cardiogenic shock.

Adım Adım Çözüm

1
Evaluate the compatibility of the newly prescribed intravenous furosemide with the continuous dobutamine infusion.
Identify that furosemide (alkaline) and dobutamine (acidic) are physically incompatible and will form a precipitate.
Mixing incompatible medications in a single line can cause crystal formation, leading to catheter occlusion or pulmonary embolism.
2
Consider alternative administration techniques using the existing single peripheral line, such as pausing the primary infusion.
Determine that pausing the dobutamine infusion is unsafe.
Dobutamine is a critical vasoactive medication with a very short half-life; interrupting the continuous flow can precipitate sudden hemodynamic instability in a client experiencing shock.
3
Select the safest administration method that adheres to pharmacological principles.
Choose to establish a second peripheral intravenous access site.
This guarantees that the life-saving dobutamine infusion remains uninterrupted while safely delivering the incompatible stat diuretic.

Anahtar Kavram

Intravenous Compatibility and Vasoactive Infusion Safety
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Konular

Pharmacological and Parenteral Therapies

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