一位病人正透過靜脈輸注氯化鉀，護理師發現輸注部位出現紅腫且疼痛。護理師應優先採取何項措施？
A nurse is caring for a client who is receiving intravenous potassium chloride. The nurse notes the site is erythematous and painful. What is the priority nursing action?
- AAssess the capillary refill評估毛細血管再充盈時間
- BSlow the infusion rate減緩輸注速率
- CDiscontinue the infusion✓ 正解停止輸注
- DApply a warm compress to the site在注射部位應用熱敷
氯化鉀具有強烈血管刺激性，若發生紅腫疼痛，代表可能已發生靜脈炎或滲漏（infiltration）。氯化鉀滲漏至皮下組織會造成嚴重組織壞死。護理師必須立即停止輸注，以防止更多的藥物進入皮下組織，隨後再評估並依機構規定處理。
Potassium chloride is strongly irritating to blood vessels, and the development of redness and pain at the site may indicate phlebitis or infiltration. Extravasation of potassium chloride into subcutaneous tissue can cause severe tissue necrosis. The nurse must immediately discontinue the infusion to prevent further drug from entering the subcutaneous tissue, and then assess and manage the situation per institutional policy.
美國多數機構針對此類高風險藥物有明確的 extravasation protocol；台灣則仰賴資深護理師臨床判斷，但原則一致。