# 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?

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> subject: Parenteral/IV Therapies  
> category: PPT

## Question

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?

## Option

1. Stop the infusion, remove the catheter, and place the arm below heart level
2. Stop the infusion, keep the catheter in place, and aspirate residual medication **✔ Correct answer**
3. Flush the catheter with saline, apply a pressure dressing, and monitor the site
4. Slow the infusion, verify the pump settings, and reassess the site after 15 minutes

**Correct answer: 2**

## 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.

## In-depth explanation

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

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