一位接受持續靜脈輸注氯化鉀的病人，護理師發現輸液部位腫脹、觸感冰冷且蒼白。護理師應優先採取哪項措施？
A nurse is caring for a client with a continuous intravenous infusion of potassium chloride. The nurse notes the site is swollen, cool to the touch, and pale. Which action should the nurse take first?
- AAssess the capillary refill評估毛細血管回充時間
- BApply a warm compress to the area在患部應用熱敷
- CSlow the rate of the infusion減慢輸注速率
- DStop the infusion immediately✓ 正解立即停止輸注
氯化鉀（Potassium chloride）屬於高警訊藥物（High-alert medication），具有強烈的組織刺激性。題幹描述的症狀（腫脹、冰冷、蒼白）是典型的靜脈外滲（Infiltration）。一旦發生外滲，藥物會滯留在皮下組織，可能引發嚴重的組織壞死（Tissue necrosis）與化學性發炎。因此，護理師應立即採取行動，停止輸注以防更多藥物進入皮下。
Potassium chloride is a high-alert medication with strong tissue irritant properties. The symptoms described in the question (swelling, coolness, pallor) are typical of intravenous infiltration. Once infiltration occurs, the medication remains in subcutaneous tissue and may cause serious tissue necrosis and chemical inflammation. Therefore, the nurse should act immediately and stop the infusion to prevent additional medication from entering the subcutaneous tissue.
美國臨床中，對於高警訊藥物（如鉀離子、血管升壓素）的外滲，護理師通常需參考醫院的「外滲處置指引」（Extravasation protocol），並立即報告醫師與藥師。