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Labetalol has been identified as a high-alert medication with a heightened risk of causing significant patient harm when used in error.undefined#ref7">7
Remember to route tubes and catheters having different purposes in different, standardized directions (e.g., IV lines routed toward the head; enteric lines toward the feet).9
Take steps to eliminate interruptions and distractions during medication preparation.
Medications should be diluted or compounded in the pharmacy before dispensing and only when recommended by the manufacturer and approved by the organization’s practice.6 Some organizations will allow medication compounding in a specific area of practice.
If dilution or reconstitution of an IV push medication becomes necessary outside of the pharmacy, the nurse should perform these tasks immediately before medication administration in a clean, uncluttered, and functionally separate location.6 The nurse should use organization-approved, readily available drug information resources and sterile equipment and supplies to dilute or reconstitute IV push medications.6
Labetalol is used to treat maternal blood pressure (BP) elevations that accompany preeclampsia, eclampsia, acute hypertension, and chronic hypertension during pregnancy. A combined alpha- and beta-adrenergic blocking agent, labetalol reduces BP by dilating arterioles and decreased total peripheral resistance, resulting in decreased BP without a substantial decrease in cardiac output.3 Labetalol has a rapid onset and is less likely than other BP medications to cause excessive hypotension, tachycardia, and rebound hypertension.
IV labetalol is a first-line medication for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period.2 The medication may be administered orally, but it is generally administered in the inpatient setting via continuous infusion or by slow IV push. IV labetalol’s onset of action is 2 to 5 minutes, its peak action occurs in 5 to 15 minutes, and its duration is 2 to 4 hours.10 Oral labetalol’s onset of action is 30 minutes; the peak effects occur in 1 to 4 hours, and the duration of action is 8 to 24 hours.10 The half-life of labetalol is 2.5 to 8 hours.10
Do not attempt to lower the patient’s BP to normal because doing so may decrease uteroplacental perfusion, causing harm to the fetus. Try to lower the systolic BP to between 140 and 160 mm Hg and the diastolic BP to between 90 and 100 mm Hg.2 Decreased uteroplacental perfusion may lead to decreased fetal oxygenation, producing a change in fetal heart rate (FHR) variability and the onset of late decelerations. Asthma, overt heart failure, greater than first-degree heart block, cardiogenic shock, severe bradycardia, or other conditions that can cause severe, prolonged hypotension, and hypersensitivity to labetalol are contraindications to its administration.3
The recommended labetalol dosing is:
The patient should be supine for IV labetalol administration.3 A pregnant patient should have a wedge pillow placed under one side to relieve compression of the aorta and inferior vena cava and avoid supine hypotension.11 Maternal labetalol treatment may cause bradycardia in the neonate.2
Adverse effects of labetalol that should be reported immediately include:
Adverse effects of labetalol that are generally mild and temporary include:10
Tubing or catheter should be traced from the patient to the point of origin before connecting or reconnecting any device or infusion.9 Tubing should be labeled at the connection site closest to the patient and at the connection site closest to the source when there are different access sites or several bags.9 Labeling reduces the chance of misconnection, especially in circumstances where multiple IV lines or devices are in use. Connections should not be forced, and equipment should only be used for its intended purpose.9 Forced connections or workarounds could indicate that the connection should not be made.
If the mother and support person express concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.
Do not use medication that is cloudy or precipitated unless such is indicated by its manufacturer as being safe.
Rationale: The port protector or cap is never reused.
The effective length of time for exposure depends on the product. Consult the manufacturer’s instructions for use.
Specific guidelines directing the appropriate technique, disinfectant, or amount of time required to clean various devices have not been determined.
There is moderate quality evidence to support the recommendation to apply mechanical friction for no less than 5 seconds.
Rationale: Puncturing the center of the diaphragm prevents damage to the diaphragm and possible leakage from the site.
Rationale: Flushing the IV line with preservative-free 0.9% sodium chloride solution prevents IV access device occlusion and ensures that all medication is delivered. Flushing the IV site at same rate as the medication was infused ensures that medication remaining in the IV needle is delivered at the correct rate.
Rationale: The usual target BP for patients with preeclampsia ranges from 140 to 150 mm Hg systolic and from 90 to 100 mm Hg diastolic.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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