A nurse is assessing an IV site and suspects extravasation from a vesicant medication. Which assessment findings and/or supportive actions may be expected? (Select all that apply)

A. Blistering or ulceration near the insertion site: Vesicant extravasation causes tissue injury due to leakage of the drug into surrounding tissue. Local findings may include blistering, ulceration, swelling, erythema, and pain at or near the IV site. These changes reflect direct cellular damage and require immediate intervention.

B. Notifying the provider promptly: Extravasation of a vesicant is a medical urgency that requires provider notification for further management. Specific antidotes, imaging, or surgical consultation may be indicated depending on the drug involved. Timely communication helps limit tissue necrosis and long-term complications.

C. Stopping the infusion immediately: Immediate discontinuation of the infusion prevents further leakage of the vesicant into surrounding tissue. The IV catheter is typically left in place initially to allow aspiration of the drug or administration of an antidote if prescribed. This step is critical to reduce the extent of tissue injury.

D. Continuing infusion at a slower rate: Slowing the infusion allows continued exposure of tissue to the vesicant and increases the risk of severe injury. Vesicant extravasation requires cessation, not adjustment, of the infusion rate

E. Continue infusion with no action: Failure to intervene allows ongoing tissue damage and increases the risk of necrosis, infection, and loss of function. Vesicant extravasation requires immediate assessment and intervention. No-action approaches are inappropriate and dangerous.