Medical Surgical Critical Care Cardiac Critical Care #2

Question

A client in the intensive care unit has an infusion of dopamine and the nurse notices the infusion site is red, irritated, and the client complains of burning at the site. What is the priority intervention for this client?

Answers

  1. Stop the dopamine infusion in 10 minutes, discontinue the IV, and call the health care provider.
    • Rationale:

      This answer is not correct because stopping the dopamine infusion in 10 minutes is wrong. The dopamine infusion should be discontinued immediately.

  2. Slow the dopamine infusion and call the health care provider.
    • Rationale:

      This answer is not correct because slowing the dopamine infusion is wrong, the infusion should be discontinued immediately.

  3. Stop the dopamine infusion, administer phentalamine through the present IV site, and call the health care provider.
    • Rationale:

      This answer is correct because stopping the dopamine infusion should be immediate, then to administer phentalamine through the present IV site, and then call the health care provider.

  4. Stop the dopamine infusion, discontinue the IV, call the health care provider, start another IV and administer phenylephrine through the new IV site.
    • Rationale:

      This answer is not correct because stopping the dopamine infusion should be immediate, but it is not necessary to start another IV site to administer phentalamine through the new IV site. It is imperative that the client receive the phentalamine through the present IV site infiltration within the first 12 hours for the best results.

Overview

Dopamine is a toxic drug that should be monitored every hour while the client is on the infusion. Extravasation from dopamine can cause ischemia and tissue necrosis. Extravasation is defined when the medication is infusing into the surrounding tissue and can cause toxic and long-term tissue death if not treated immediately.

Explanation

Learning Outcomes

Dopamine extravasation is treated with phentolamine mesylate injected into the extravasation area within the first 12 hours. This is the only treatment approved for vasopressor extravasation. Phentolamine is the antidote to counteract vasoactive agents. Vasoactive agents include dopamine, phenylephrine, epinephrine, and norepinephrine and cause vasoconstriction by the alpha-receptors being stimulated.

Test Taking Tip

Know the antidote for vasoactive agents and how and when to infuse for the best results.

Video Rationale