# During peripheral doxorubicin infusion, a client develops new burning and stinging, localized erythema, a 3 cm area of swelling, and a high-pressure pump alarm at the IV site. Blood return remains present on gentle aspiration; temperature is 36.9 C and the client has no dyspnea. Place the actions in the safest order after recognizing suspected doxorubicin extravasation.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513946&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

During peripheral doxorubicin infusion, a client develops new burning and stinging, localized erythema, a 3 cm area of swelling, and a high-pressure pump alarm at the IV site. Blood return remains present on gentle aspiration; temperature is 36.9 C and the client has no dyspnea. Place the actions in the safest order after recognizing suspected doxorubicin extravasation.

Apply intermittent ice and elevate the extremity while the antidote is prepared.

Stop the doxorubicin infusion and disconnect the tubing.

Begin prescribed dexrazoxane through a vein in another extremity within 6 hours after removing cooling for the required interval.

Attempt to aspirate residual drug through the retained catheter without flushing.

Notify the oncology team, estimate the exposure, document the site, and activate the protocol.

## Explanation

The sequence first stops exposure, then aspirates through the retained line, activates the protocol, provides local care, and delivers time-sensitive dexrazoxane through separate access.

## In-depth explanation

Quick answer
Use the sequence stop → aspirate → activate → cool/elevate → antidote.

Why this is correct
The earliest actions limit tissue exposure. Documentation and protocol activation follow without delaying care, and dexrazoxane is administered as soon as possible within the labeled 6-hour window.

Easy analogy or mental picture
Turn off the leak before calling the repair crew; then contain it while the definitive response arrives.

Memory hook
Exposure control comes before documentation and definitive treatment.

NCLEX decision rule
Order actions by immediate harm prevention, recovery of residual drug, team activation, local care, and time-sensitive therapy.

Why the other choices are wrong
Giving the antidote before stopping exposure or flushing first reverses the safety sequence and can increase injury.References
1DailyMed: Doxorubicin Extravasation ManagementAspiration, no flushing, ice, elevation, and dexrazoxane consideration
2FDA: Totect Prescribing InformationAnthracycline extravasation treatment within 6 hours and renal dose modification
3ONS/ASCO Antineoplastic Extravasation GuidelineEvidence-based antidote, thermal care, and escalation framework

## Clinical scenario

Anthracycline extravasation action sequence
Order exposure control, aspiration, protocol activation, local care, and prescribed dexrazoxane without letting documentation delay the first protective actions.

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