رجل عمره ٦٧ سنة في الصدمة الإنتانية من التهاب رئوي، يأخذ نورأدرينالين عبر كانيولا طرفية في الساعد مؤقتاً حتى تركيب خط مركزي. الضغط ٩٨/٦٠ على الدواء. لاحظ الممرض أن الجلد حول الكانيولا صار شاحباً وبارداً ومتورماً. ما التصرف الصحيح؟

A 67-year-old man in septic shock from pneumonia is receiving noradrenaline via a forearm peripheral cannula until a central line is placed. BP is 98/60 on the drug. The nurse notes the skin around the cannula is pale, cold and swollen. What is the correct action?

1. Stop the infusion at that site and notify the prescriber for extravasation care
2. Increase the rate because pallor means poor circulation
3. Apply cold packs and continue through the same cannula
4. Remove the cannula at once, apply a pressure dressing and continue the infusion in the other arm

Answer: A) Stop the infusion at that site and notify the prescriber for extravasation care. Noradrenaline extravasation causes vasoconstriction and tissue necrosis. The infusion is stopped and resited, the cannula left briefly to aspirate and give the antidote if in protocol (such as phentolamine), and the prescriber informed.