# Twenty minutes into a peripheral doxorubicin infusion through a forearm catheter inserted today, the client reports new burning and stinging at the IV site. The nurse finds localized erythema and a 3 cm area of swelling around the insertion site, and the infusion pump shows a high-pressure alarm. There is no red streaking along the vein, no palpable cord, and no hives. Blood return is present on gentle aspiration. Temperature is 36.9°C (98.4°F), blood pressure 118/70 mm Hg, and the client has no dyspnea, chest tightness, or itching. Complete the diagram by selecting the problem the client is most likely experiencing, 2 actions the nurse should take to address that problem, and 2 parameters the nurse should monitor to assess the client's progress.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617375&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Twenty minutes into a peripheral doxorubicin infusion through a forearm catheter inserted today, the client reports new burning and stinging at the IV site. The nurse finds localized erythema and a 3 cm area of swelling around the insertion site, and the infusion pump shows a high-pressure alarm. There is no red streaking along the vein, no palpable cord, and no hives. Blood return is present on gentle aspiration. Temperature is 36.9°C (98.4°F), blood pressure 118/70 mm Hg, and the client has no dyspnea, chest tightness, or itching. Complete the diagram by selecting the problem the client is most likely experiencing, 2 actions the nurse should take to address that problem, and 2 parameters the nurse should monitor to assess the client's progress.

Condition

Select 1
Doxorubicin extravasation
Doxorubicin flare reaction
Infusion-related chemical phlebitis
Localized hypersensitivity reaction

Actions to take

Select 2
Stop the infusion and disconnect the tubing
Apply a warm compress to the site
Administer the prescribed IV diphenhydramine
Slow the rate and recheck the site in 15 minutes
Aspirate residual drug through the catheter

Parameters to monitor

Select 2
Body temperature
Size of the marked area of erythema
Spread of wheals or urticaria
Blistering or blanching of the skin
Palpable cord along the vein above the site

## Explanation

Burning, swelling around the site, and a pressure alarm during a vesicant infusion indicate extravasation even when blood return is present. The nurse stops the infusion with the tubing disconnected and aspirates residual drug through the catheter that is already in place. The marked area of erythema and any blistering or blanching are trended to detect progression toward ulceration.

## In-depth explanation

Quick answer
Doxorubicin extravasation. Actions: stop the infusion and disconnect the tubing; aspirate residual drug through the catheter. Monitor: size of the marked area of erythema, and blistering or blanching of the skin.

Why this is correct
Doxorubicin is a vesicant that binds DNA in tissue and can cause progressive necrosis. Swelling around the site and a rising pump pressure show fluid is entering tissue; blood return does not rule out extravasation because the catheter tip can sit partly in the vein. Stopping the infusion ends further exposure, and aspirating through the catheter already in place removes some of the drug before it spreads. The marked margin and skin integrity show whether the injury is progressing.

Easy analogy or mental picture
Imagine ink leaking from a pen into paper: stop pressing (stop the infusion), soak up what you can (aspirate), and watch how far the stain spreads (marked margin and skin integrity).

Memory hook
Vesicant leak: stop it, draw it back, mark the edge.

NCLEX decision rule
When a vesicant may be infiltrating, stop the infusion immediately and act on suspicion; do not rely on blood return to decide that the line is safe.

Why the other choices are wrong
A flare reaction causes red streaking along the vein or itching without pain or swelling and fades within about 30 minutes; here there is swelling and no streaking. Phlebitis produces a tender venous cord, which is absent, so a cord is the wrong parameter. A hypersensitivity reaction causes hives and itching, so diphenhydramine and wheal spread fit that differential. Warm compresses are used for vinca alkaloid extravasation, not anthracyclines. Slowing the rate and rechecking later keeps a vesicant flowing into tissue while the nurse waits. Temperature tracks infection, not tissue injury.

References
1DailyMed — Doxorubicin hydrochloride injection prescribing informationDoxorubicin is a vesicant; extravasation can cause severe local tissue injury and necrosis.
2ONS/ASCO antineoplastic extravasation guidelineRecognition of extravasation and immediate interruption of the infusion with aspiration of residual drug.

## Clinical scenario

Case update
Twenty minutes into peripheral doxorubicin, the client has burning, localized erythema, 3 cm of swelling, and a high-pressure alarm while blood return is still present.

## Key concepts

- **Vesicant** — A drug that can cause blistering and tissue necrosis if it escapes the vein.
- **Flare reaction** — A transient local red streaking or itching along the vein during doxorubicin infusion without swelling or pain.
- **Infusion pressure alarm** — A pump alert signaling rising resistance to flow, which can occur when fluid enters tissue instead of the vein.

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