The client who is receiving intravenous chemotherapy (into a peripheral line) with an agent that is an irritant says that her arm burns terribly at and around the IV site. What is the nurse's best first action?
A. Check for a blood return.
B. Slow the rate of infusion.
C. Discontinue the infusion.
D. Apply a cold compress to the site.
C
Irritants and vesicants can both cause tissue damage. Even if the IV has a good blood return, some of the chemotherapy can still be leaking into the tissues. Slowing the rate of infusion is not sufficient to prevent further leakage and damage. Applying a cold compress may or may not be the correct action, depending on the specific agent; however, the compress would only be applied after the infusion has been discontinued.
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