# During IV vincristine infusion, a client reports burning at the IV site. The nurse notes swelling and absent blood return. Which is the priority action?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

During IV vincristine infusion, a client reports burning at the IV site. The nurse notes swelling and absent blood return. Which is the priority action?

## Option

1. Apply ice and continue infusion
2. Remove the IV and reinsert in the same vein
3. STOP the infusion immediately, leave the IV catheter in place, aspirate residual drug, notify the provider, follow extravasation protocol (warm compress and hyaluronidase for vincristine), elevate limb, and document **✔ Correct answer**
4. Increase the rate to flush the line

**Correct answer: 3**

## Explanation

Correct (2): Vincristine is a vesicant — extravasation requires immediate STOP, leave catheter in to aspirate residual, antidote per drug. Vinca alkaloids: warm compress + hyaluronidase. Anthracyclines: cold compress + dexrazoxane or DMSO. NEVER give vincristine intrathecally (fatal). (1,3,4) Worsen.

## In-depth explanation

Memory Tip Extravasation antidotes — "WARM-Vinca" (hyaluronidase) vs "COLD-Anthracycline" (dexrazoxane/DMSO). Vincristine IT = fatal — never label syringe IV/IT together.

## Clinical scenario

Scenario Adult receiving vincristine IV via peripheral line; reports burning, swelling and absent blood return.

## Key concepts

- **Vesicant chemotherapy** — Drugs causing severe tissue necrosis on extravasation; vincristine, anthracyclines.
- **Vinca alkaloid extravasation** — Warm compress + hyaluronidase; opposite of anthracycline.
- **Vincristine fatal IT error** — Never administer intrathecally — fatal; ISMP recommends mini-bag not syringe.

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