# A nurse is administering doxorubicin (a vesicant chemotherapy agent) through a peripheral IV when the patient reports burning at the IV site. The nurse notes swelling and erythema. Which actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374920&lang=en  
> language: en  
> subject: Safety and Infection Prevention and Control  
> category: SIPC

## Question

A nurse is administering doxorubicin (a vesicant chemotherapy agent) through a peripheral IV when the patient reports burning at the IV site. The nurse notes swelling and erythema. Which actions are appropriate? Select all that apply.

1

Continue the infusion at a slower rate and apply a warm compress to the site, as mild irritation and swelling can commonly occur with doxorubicin administration.

2

Notify the oncology provider STAT and obtain the institution-specific extravasation kit; mark the affected area to monitor for spread.

3

STOP the infusion immediately but DO NOT remove the IV catheter; aspirate any residual drug from the line through the existing catheter before removal.

4

Administer the antidote per protocol — for anthracyclines (doxorubicin) this is dexrazoxane (Totect/Savene) IV in the OPPOSITE limb within 6 hours, plus topical DMSO; for vinca alkaloids (vincristine) hyaluronidase SC.

5

Apply COLD compresses for anthracycline extravasations (doxorubicin) and WARM compresses for vinca alkaloid extravasations.

## Explanation

Vesicant extravasation requires immediate action: STOP infusion, KEEP catheter for residual aspiration, notify provider STAT, give antidote per protocol (dexrazoxane for anthracyclines via opposite limb + topical DMSO; hyaluronidase for vincas), and apply temperature per drug class — COLD for anthracyclines (vasoconstriction limits spread), WARM for vinca alkaloids (vasodilation aids dispersion). Choice 1 is dangerous — continuing infusion worsens tissue damage and necrosis.

## In-depth explanation

Anthracycline (doxorubicin) extravasation = COLD compress + dexrazoxane in OPPOSITE limb. Vinca alkaloid (vincristine) extravasation = WARM compress + hyaluronidase SC at site. Memorize: cold for anthracyclines (red drugs), warm for vincas (clear drugs). Tissue necrosis can occur within hours; central line preferred for vesicants.

## Clinical scenario

Patient receiving **doxorubicin** through a peripheral IV develops **burning, swelling, and erythema at the IV site** — suspected vesicant extravasation. The unit follows oncology extravasation protocol.

## Key concepts

- **Vesicant chemotherapy** — Drugs causing tissue necrosis on extravasation: anthracyclines (doxorubicin, daunorubicin), vinca alkaloids (vincristine, vinblastine), mechlorethamine.
- **Dexrazoxane (Totect)** — Antidote for anthracycline extravasation; given IV in opposite limb within 6 hours; reduces tissue damage.
- **Hyaluronidase + warm compress** — Antidote for vinca alkaloid extravasation; SC at site dispersing the drug; warm compress aids absorption.

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