The nurse is caring for a client who just had a subclavian central venous catheter inserted. Which symptom should the nurse recognize as setting a priority for this client's care?

A. Changing the client's arm position, such as raising or lowering it, could potentially improve flow by altering the gravitational pull on the IV solution. For example, raising the arm could increase flow due to increased pressure, while lowering it could decrease flow. However, this approach may not always be effective and should be done cautiously to avoid discomfort or compromising the integrity of the IV site.
B. Using an infusion pump can help regulate the flow rate of the IV solution more accurately compared to gravity alone. However, if the IV is running slowly due to factors unrelated to the infusion rate setting, such as a partial blockage or resistance in the IV line, using an infusion pump may not necessarily improve the flow rate.
C. Lowering the height of the IV pole can increase the gravitational force acting on the IV solution, potentially improving flow. This adjustment can help overcome minor obstructions in the IV line and facilitate better flow. However, it should be done cautiously to avoid excessive pressure on the IV site or causing discomfort to the client.
D. Opening the clamp fully for an extended period is not a recommended approach. It could lead to rapid infusion or an excessive flow rate, increasing the risk of complications such as fluid overload or vein irritation. Additionally, this action does not address the underlying reason for the slow flow rate and may not effectively resolve the issue.

B. When a client experiences symptoms of extravasation, such as pain, burning, and swelling, especially with a vesicant medication, the priority is to stop the infusion and remove the catheter immediately to prevent further tissue damage. Removing the catheter promptly helps minimize the amount of medication that may have leaked into the surrounding tissues.
A. Elevating the extremity on a pillow may help reduce swelling and discomfort in some cases, but it is not the first action the nurse should take when a vesicant medication has caused pain, burning, and swelling at the IV site.
C. Keeping the catheter in place is not advisable when extravasation has occurred, especially with a vesicant medication. Continuing the infusion could lead to further tissue damage and exacerbate the client's symptoms. Removing the catheter is necessary to prevent additional medication from entering the surrounding tissues.
D. While applying a cool compress may provide temporary relief from discomfort, it is not the first action the nurse should take when managing extravasation caused by a vesicant medication. The priority is to stop the infusion, remove the catheter, and assess the extent of tissue damage. Cool compresses may be used after the catheter removal to help reduce swelling and discomfort.