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Zorluk: ZorPharmacological and Parenteral Therapies

While assessing a client who is being treated for severe hypotension, the nurse examines the peripheral intravenous access site where dopamine is infusing. The area is markedly pale, edematous, and cold to the touch, and the client complains of an intense burning sensation. The nurse immediately halts the infusion pump. Which action is the most appropriate next step for the nurse to take?

  1. Leave the catheter in place to aspirate residual medication from the hub and prepare to administer prescribed phentolamine into the affected tissue.Cevap
  2. B
    Flush the intravenous line with a bolus of 0.9% sodium chloride0.9\% \text{ sodium chloride} to dilute the concentrated medication in the surrounding tissues.
  3. C
    Remove the intravenous catheter immediately, elevate the extremity, and apply a cold compress to limit the spread of the medication.
  4. D
    Decrease the infusion rate by half and notify the healthcare provider, as the client is experiencing a common localized reaction.

Cevap

Leave the catheter in place to aspirate residual medication from the hub and prepare to administer prescribed phentolamine into the affected tissue.
Dopamine is a potent alpha-adrenergic agonist and a known vesicant. Extravasation into the subcutaneous tissues causes profound localized vasoconstriction, leading to rapid ischemia and severe tissue necrosis. The evidence-based standard of care for dopamine extravasation is to stop the infusion immediately, leave the catheter in place to aspirate any remaining medication from the hub (minimizing further exposure), and then administer phentolamine (an alpha-adrenergic antagonist) subcutaneously into the affected tissue. Phentolamine blocks the alpha receptors, inducing local vasodilation, restoring blood flow, and preventing tissue death.

Adım Adım Çözüm

1
Identify the complication occurring at the peripheral intravenous site.
The clinical signs of marked blanching, coolness, edema, and intense burning indicate extravasation of dopamine, which is a potent vesicant.
Accurate assessment of the adverse reaction dictates the specific emergency protocol required to prevent severe injury.
2
Determine the immediate physiological priority.
The infusion has been correctly halted by the nurse, preventing further vesicant medication from entering the extravascular tissue.
Stopping the source of tissue injury is always the first definitive action during extravasation.
3
Select the appropriate secondary interventions to minimize tissue damage.
The catheter must remain in place temporarily to allow the nurse to aspirate residual drug from the hub before administration of the antidote.
Prematurely removing the catheter eliminates the route for aspiration, while flushing would forcefully push more vesicant into the fragile tissue.
4
Identify the correct pharmacological antidote for dopamine extravasation.
Phentolamine, an alpha-adrenergic blocker, is the required antidote and is administered into the affected surrounding tissues.
Phentolamine induces local vasodilation to counteract the severe, localized vasoconstriction and ischemia caused by the dopamine.

Anahtar Kavram

Management of Vesicant Extravasation
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Konular

Pharmacological and Parenteral Therapies

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