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Difficulty: HardPharmacological and Parenteral Therapies

A nurse evaluates a client with distributive shock who is receiving a continuous intravenous (IV) infusion of norepinephrine through a peripheral venous catheter in the right forearm. The nurse observes that the skin around the insertion site is severely blanched, cold to the touch, and edematous. Which of the following actions should the nurse perform? Select all that apply.

  1. Stop the norepinephrine infusion immediately.Answer
  2. B
    Quickly remove the peripheral IV catheter from the right forearm.
  3. Attach a syringe to the IV hub and aspirate residual medication.Answer
  4. D
    Flush the IV catheter with 10 mL of 0.9% sodium chloride to ensure patency.
  5. Prepare to administer prescribed subcutaneous phentolamine around the affected site.Answer
  6. F
    Establish a new IV access distal to the extravasation site on the right forearm.

Answer

The correct actions are to stop the infusion immediately, attach a syringe to aspirate any residual medication, and prepare to administer subcutaneous phentolamine.
Norepinephrine is a potent vesicant that causes severe vasoconstriction, leading to localized tissue ischemia and necrosis if extravasation occurs. The immediate priorities are to stop the infusion to halt further infiltration, aspirate any residual drug from the catheter to minimize tissue exposure, and prepare to administer an alpha-adrenergic antagonist, such as phentolamine, into the surrounding tissues to induce vasodilation and restore perfusion.

Step-by-Step Solution

1
Identify signs of vesicant extravasation.
The nurse recognizes blanching, coldness, and edema as indicators of norepinephrine tissue infiltration.
Norepinephrine is a severe vesicant that causes intense vasoconstriction, requiring immediate intervention to prevent tissue necrosis.
2
Halt the medication delivery.
The norepinephrine infusion is stopped immediately.
Stopping the pump prevents any additional vesicant from entering the subcutaneous tissue.
3
Evacuate the remaining medication.
A syringe is used to aspirate residual drug from the catheter hub while leaving the catheter in place.
Aspiration removes the vesicant without pushing it further into the tissue, minimizing damage and maintaining a route if intravenous antidote administration is required by protocol.
4
Administer the specific antidote.
Phentolamine is prepared for subcutaneous injection around the site.
Phentolamine reverses the severe localized vasoconstriction and ischemia caused by the extravasated norepinephrine.

Key Concept

Vesicant Extravasation Management
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Topics

Pharmacological and Parenteral Therapies

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