— 藥理與非經腸給藥 · HARD · MCQ —
一位病人正接受氯化鉀靜脈輸注，護理師發現注射部位腫脹、冰冷且蒼白。護理師應優先採取何種措施？
A client is receiving an intravenous infusion of potassium chloride. The nurse notices the site is swollen, cool, and pale. Which action is the priority?
- AFlush the IV line to check patency沖洗靜脈通路以確認暢通
- BDiscontinue the infusion✓ 正解停止輸注
- CNotify the physician to order an antidote通知醫師開立解毒劑
- DApply a warm compress施加熱敷
— Explanation · 中文詳解 —
輸注部位出現腫脹、冰冷、蒼白顯示發生滲漏（infiltration）。氯化鉀具有強烈刺激性，若發生滲漏會引起組織壞死。優先動作必須立即停止輸注以防更多藥物進入皮下組織，隨後移除導管並依醫院政策評估是否需處理（如冷敷或熱敷）。
Swelling, coolness, and pallor at the IV site indicate infiltration, where potassium chloride has leaked into the surrounding tissue. Because potassium is highly irritating and can cause severe tissue necrosis, the nurse must immediately discontinue the infusion to prevent further damage.
✦ 台美臨床差異
台灣與美國對於發生滲漏的處理原則一致，氯化鉀等高警訊藥物一旦懷疑滲漏，立即拔針為絕對準則。