A nurse in the intensive care unit is caring for a client who is receiving a continuous intravenous infusion of norepinephrine through a peripheral venous catheter. During the hourly assessment, the nurse notes blanching, coolness, and swelling at the insertion site, and the client reports severe burning pain. In what order should the nurse perform the following actions to minimize tissue injury? Arrange the actions from first to last.
- 1Stop the continuous intravenous infusion of norepinephrine.
- 2Disconnect the administration tubing while leaving the intravenous cannula in place.
- 3Attempt to aspirate residual medication from the intravenous cannula using a small syringe.
- 4Administer the prescribed tissue antidote through the existing intravenous cannula.
- 5Elevate the affected extremity above the level of the client's heart.
Cevap
The correct sequence is to first stop the infusion, disconnect the tubing while leaving the cannula in place, aspirate residual medication, administer the prescribed antidote through the existing cannula, and finally elevate the extremity.
Norepinephrine is a potent alpha-adrenergic agonist and a known vesicant. When it extravasates into surrounding tissues, it causes severe, localized vasoconstriction that rapidly leads to tissue ischemia and necrosis. Risk reduction protocols dictate a specific sequence to mitigate this damage. The very first action must always be stopping the infusion. However, unlike a standard IV infiltration where the catheter is immediately pulled, the cannula must be left in place. This allows the nurse to aspirate any remaining drug and provides a direct route to administer a neutralizing antidote (such as phentolamine) deep into the affected tissues. Only after the active chemical threat is managed should supportive measures like elevation be implemented.
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Anahtar Kavram
Vesicant Extravasation Management