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Zorluk: OrtaPharmacological and Parenteral Therapies

A client admitted with acute decompensated heart failure is receiving a continuous intravenous infusion of milrinone. The healthcare provider prescribes a one-time dose of intravenous furosemide 40 mg40\text{ mg} to manage worsening pulmonary edema. The client currently has a single peripheral intravenous access site. After consulting the facility's drug reference, the nurse notes that furosemide and milrinone are incompatible. Which of the following is the most appropriate action for the nurse to take?

  1. Establish a second peripheral intravenous access site to administer the furosemide.Cevap
  2. B
    Pause the milrinone infusion, flush the line with 0.9% sodium chloride0.9\%\text{ sodium chloride}, administer the furosemide, flush again, and resume the milrinone.
  3. C
    Administer the furosemide slowly through the Y-site port closest to the client to minimize the contact time between the two medications.
  4. D
    Contact the healthcare provider to request changing the intravenous furosemide to an equivalent oral dose to avoid compatibility issues.

Cevap

Establish a second peripheral intravenous access site to administer the furosemide.
Furosemide and milrinone are chemically incompatible and cannot be mixed. While stopping an infusion and flushing the line is an acceptable practice for routine continuous fluids (like normal saline), milrinone is a critical continuous inotropic infusion. Pausing a vasoactive medication to administer an IV push can lead to an abrupt drop in cardiac output and severe hemodynamic instability. Therefore, the safest and most appropriate action is to establish a new, separate intravenous access site.

Adım Adım Çözüm

1
Identify the incompatibility between the prescribed medications.
The nurse confirms that intravenous furosemide and milrinone cannot be mixed or administered through the same line concurrently.
Mixing incompatible medications can cause precipitation, leading to line occlusion or emboli.
2
Evaluate the nature of the continuous infusion.
The nurse recognizes that milrinone is a critical continuous inotropic medication used to support cardiac output in heart failure.
Understanding the pharmacology of the continuous infusion dictates whether it is safe to temporarily pause the medication.
3
Determine the safest administration strategy.
The nurse concludes that pausing the milrinone is unsafe due to the risk of hemodynamic collapse, and concurrent administration is unsafe due to incompatibility.
A second, independent intravenous line is required to safely administer the furosemide without interrupting life-sustaining therapy.

Anahtar Kavram

Intravenous Medication Compatibility and Vasoactive Infusion Safety
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Konular

Pharmacological and Parenteral Therapies

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