Managing an Infiltrated IV with Vesicant Medication

Scenario

While administering IV vancomycin, you notice the patient’s arm is swollen, cool, and painful near the IV site.
The infusion pump alarms “high pressure,” and the patient reports burning at the site.

Question: What should you do immediately, and how do you manage a potential vesicant extravasation?

Best Practice Answer

1. Recognize the Emergency — Treat as Vesicant Extravasation Until Proven Otherwise:
   Vesicants (e.g., vancomycin, potassium, chemotherapy agents) can cause tissue necrosis if they leak into surrounding tissue.
   Never flush or restart infusion until extravasation is ruled out.

2. Immediate Nursing Actions:

   • Stop the infusion immediately.
   • Leave the IV catheter in place — do not remove it yet.
   • Aspirate any residual medication from the catheter with a syringe to minimize tissue damage.
   • Disconnect the tubing but keep the line intact for possible antidote administration.
   • Notify the provider and pharmacy immediately.
   • Mark and measure the affected area (redness, swelling, blanching).

3. Apply Appropriate Compress and Elevation:

   • Warm compress: For non-vesicant irritants or drugs that disperse with vasodilation (e.g., vancomycin).
   • Cold compress: For cytotoxic agents (e.g., anthracyclines, dopamine) to limit spread.
   • Elevate the limb to promote venous return and reduce edema.

4. Collaborate for Antidote or Neutralizing Agent:

   • Administer antidotes through the existing catheter if applicable (e.g., hyaluronidase for vinca alkaloids).
   • If no antidote available, remove the catheter after aspiration and compress application.
   • Continue close neurovascular monitoring of the affected site (cap refill, sensation, color).

5. Documentation and Reporting:

   • Record:
     • Medication name, concentration, dose, and time of incident.
     • Description of site appearance and interventions performed.
     • Provider and pharmacy notification times.
   • Complete a safety/occurrence report as per hospital policy.
   • Take clinical photos if institutional protocol allows for injury documentation.

6. Patient Education and Monitoring:

   • Explain what happened calmly, reassure the patient, and inform them of next steps.
   • Monitor the site for necrosis, blistering, or persistent pain over the next 24–48 hours.
   • Report any worsening condition immediately for possible surgical evaluation.

Real-World Application

Extravasation events test your ability to act calmly but urgently while following hospital-specific safety protocols.
Interviewers assess your awareness of:

• Vesicant vs. irritant classification
• Early recognition and prevention of tissue injury
• Communication with pharmacy and providers

This scenario is especially common in oncology, med-surg, and IV therapy interviews.

Tip: In interviews, summarize decisively —
“If a vesicant infiltrates, I stop the infusion, leave the catheter for aspiration or antidote, notify the provider, apply the correct compress, and document thoroughly.”
That answer demonstrates technical expertise, safety prioritization, and procedural precision.