During a peripheral IV infusion of doxorubicin, a client reports burning at the site. The nurse observes swelling and cannot obtain blood return. Which action should the nurse take first?
1Stop the infusion, remove the catheter, and place the arm below heart level
2Stop the infusion, keep the catheter in place, and aspirate residual medication✓ Correct answer
3Flush the catheter with saline, apply a pressure dressing, and monitor the site
4Slow the infusion, verify the pump settings, and reassess the site after 15 minutes
Explanation
Suspected vesicant extravasation requires stopping the infusion while leaving the catheter available for aspiration and possible antidote delivery. Flushing, removing access immediately, or continuing the infusion can spread tissue exposure.
Quick answer Stop doxorubicin immediately, keep the catheter in place, and attempt aspiration of residual medication. This limits additional tissue exposure while preserving access for the extravasation protocol.
Why this is correct Burning, swelling, and loss of blood return during vesicant administration are warning signs of extravasation. Stopping flow prevents more drug from entering tissue, while the existing catheter may be used to withdraw residual drug or give an agent-specific antidote according to protocol.
Easy analogy or mental picture Picture a leaking hose carrying a tissue-damaging liquid. First close the valve, then use the hose to pull back what can be removed; do not flush the leak farther into the ground. The analogy does not determine the later compress or antidote, which depends on the drug.
Memory hook Suspect a vesicant leak: stop flow, keep access, aspirate, then follow the drug-specific protocol.
NCLEX decision rule When pain, swelling, or absent blood return appears during a vesicant infusion, stop the infusion before any other intervention. Do not flush, and do not remove the catheter until aspiration and antidote needs are evaluated.
Why the other choices are wrong Immediate catheter removal loses a route for aspiration or antidote. Flushing can push more vesicant into tissue. Slowing the infusion continues exposure despite multiple extravasation cues, and reassessment should not delay stopping the drug.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
ONS/ASCO Guideline on Antineoplastic ExtravasationOncology Nursing Society and American Society of Clinical Oncology, 2025