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Difficulty: MediumPharmacological and Parenteral Therapies

A client in the intensive care unit is receiving a continuous intravenous (IV) infusion of dopamine hydrochloride via a peripheral venous catheter. The client reports a severe, stinging pain at the insertion site. Upon assessment, the nurse observes that the surrounding tissue is blanched, edematous, and cold to the touch. Which of the following is the nurse's most appropriate initial action?

  1. Stop the medication infusion immediately and leave the intravenous catheter in place.Answer
  2. B
    Discontinue the electronic infusion pump and promptly remove the peripheral catheter.
  3. C
    Elevate the client's affected arm on a pillow and notify the primary healthcare provider.
  4. D
    Flush the peripheral catheter with 0.9% sodium chloride to assess the extent of the tissue infiltration.

Answer

The correct action is to immediately stop the dopamine infusion while keeping the IV catheter in place.
The assessment findings indicate extravasation of dopamine, which is a potent vesicant. The immediate priority is to stop the infusion to prevent any further medication from entering and damaging the subcutaneous tissue. The intravenous catheter must be left in place because it provides the most direct access route for the healthcare provider to aspirate residual medication and for the nurse to administer the prescribed antidote, phentolamine (an alpha-adrenergic blocker), directly into the infiltrated area.

Step-by-Step Solution

1
Analyze the clinical assessment findings presented in the scenario.
The client has pain, blanching, edema, and coldness at the IV site while receiving dopamine, which clearly indicates extravasation.
Dopamine is a vesicant medication that causes severe local vasoconstriction and rapid tissue necrosis if it leaks into the surrounding subcutaneous tissue.
2
Determine the highest priority nursing intervention for a vesicant extravasation.
The absolute first action is to stop the infusion to halt any further infiltration of the tissue-damaging medication.
Stopping the source of harm is the foundational principle of patient safety and priority-setting frameworks.
3
Evaluate the subsequent steps in the standard extravasation protocol.
The IV catheter must be left in place rather than removed immediately.
Leaving the catheter intact provides direct venous and tissue access to aspirate residual drug and administer the specific pharmacological antidote (phentolamine) directly to the affected area.

Key Concept

Management of vesicant extravasation requires immediately stopping the infusion and retaining the catheter to administer the localized antidote.
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Topics

Pharmacological and Parenteral Therapies

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