# Vincristine IV輸注中，個案主訴IV部位灼熱，護理師發現腫脹且無回血。優先行動是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391863&lang=zh-tw  
> language: zh-TW  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## 題目

Vincristine IV輸注中，個案主訴IV部位灼熱，護理師發現腫脹且無回血。優先行動是什麼？

## 選項

1. 冰敷並繼續輸注
2. 拔除IV並在同一條靜脈重新置入
3. 立即停止輸注，保留IV導管，抽吸殘餘藥物，通知醫療者，依外滲流程處理（vincristine用溫敷和hyaluronidase），抬高肢體並記錄 **✔ 正確答案**
4. 提高速率以沖洗管路

**正確答案: 3**

## 解析

正確（2）：Vincristine是vesicant，外滲時需立即停止，保留導管以抽吸殘藥，並依藥物使用解毒處置。Vinca alkaloid：溫敷＋hyaluronidase；anthracycline：冷敷＋dexrazoxane或DMSO。絕不可將vincristine髓腔內給藥，會致命。（1、3、4）會惡化。

## 深入解析

記憶提示 外滲處理：Vinca用溫敷，anthracycline用冷敷。Vincristine髓腔內給藥是致命錯誤。

## 臨床情境

情境 成人經末梢管路輸注vincristine IV，出現灼熱、腫脹且無回血。

## 重要概念

- **vesicant化療藥物** — 外滲時會造成嚴重組織壞死的藥物，如vincristine與anthracycline。
- **vinca alkaloid外滲** — 處置為溫敷加hyaluronidase，與anthracycline相反。
- **vincristine髓腔內致命錯誤** — 絕不可髓腔內給藥，會致命；ISMP建議用mini-bag而非syringe。

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