A patient undergoing hydration therapy reports pain at the infusion site. On assessment, the nurse notices the surrounding area is swollen and cooler than adjacent tissue. What action should the nurse take first?
Elevate the affected arm to help reduce swelling in the area.
Stop the infusion promptly to prevent additional tissue complications.
Adjust the infusion rate and observe the site for any changes.
Apply a warm compress to alleviate the swelling and improve comfort.
The correct action is to stop the infusion. Pain, swelling, and coolness near the infusion site indicate potential infiltration, where the fluid moves into surrounding tissue instead of the blood vessel. Continuing the infusion or delaying action may exacerbate tissue damage. While applying a compress or elevating the limb could be helpful secondary measures, these should only be done after stopping the infusion to minimize further complications. Observing the site or adjusting the flow rate instead of discontinuing the line can allow the problem to persist or worsen.
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