Norepinephrine is infusing through a peripheral IV. The site becomes pale, cool, swollen, and painful. Which action should the nurse take?
1Slow the infusion, flush the catheter with saline, and apply ice while obtaining a distal IV site.
2Stop the infusion, leave the catheter for aspiration, notify the provider, and prepare phentolamine infiltration.✓ Correct answer
3Remove the catheter immediately, massage the site firmly, and restart norepinephrine in the same extremity.
4Continue the infusion until central access is available because interrupting norepinephrine can cause hypotension.
Explanation
Pallor, coolness, swelling, and pain at a peripheral norepinephrine site indicate extravasation with risk of ischemia and tissue necrosis. Stop infusion through that catheter without flushing, leave it in place initially for aspiration, notify the provider, and prepare prompt phentolamine infiltration according to protocol. Resume vasopressor support through new appropriate access while the affected site is treated and monitored.
Clinical reasoning Norepinephrine produces intense alpha-adrenergic vasoconstriction. In subcutaneous tissue, that effect can rapidly cause ischemia, sloughing, and necrosis.
Decision rule Stop delivery into the injured site, do not flush, aspirate through the existing catheter when possible, and treat urgently with protocol-directed phentolamine. Establish new access promptly so hemodynamic support can continue safely.