A nurse is monitoring a client who is receiving a vesicant for chemotherapy via an IV infusion and notices the client has developed extravasation. Identify the sequence of steps the nurse should take. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Stop the infusion. Disconnect the IV tubing from the IV hub. Aspirate the medication from the IV catheter. Elevate the affected extremity. Brief Introduction: Extravasation is a severe clinical complication where a vesicant medication leaks from the intravascular space into the surrounding dermal or subcutaneous tissue. Vesicants, such as certain chemotherapeutic agents, cause cellular necrosis, tissue sloughing, and permanent nerve damage upon contact with extravascular structures. Emergency management focuses on immediate cessation of the insult and the removal of as much residual toxin as possible to mitigate localized destruction. Rationale: A. Disconnecting the IV tubing from the IV hub is the second priority action. Once the pump is deactivated, the tubing must be removed while leaving the catheter in place to serve as a conduit for further intervention. This step prepares the site for aspiration and prevents any further residual medication within the line from being accidentally flushed into the compromised tissue. B. Elevating the affected extremity is the final step in the immediate response sequence. Elevation utilizes gravity to promote venous return and lymphatic drainage, which helps reduce localized edema and limits the spread of the vesicant within the interstitial spaces. This maneuver is part of supportive care and should only be performed after the chemical threat has been physically addressed. C. Stop the infusion is the absolute first action the nurse must perform the moment extravasation is suspected. Continued administration of a vesicant exponentially increases the volume of tissue exposed to the toxin, leading to wider areas of necrosis. Halting the flow immediately limits the scope of the injury and is the highest priority for limb preservation and safety. D. Aspirate the medication from the client's IV catheter is performed after the tubing is disconnected but before the catheter is removed. Using a syringe to pull back on the hub allows the nurse to extract residual vesicant still sitting in the catheter and the immediate extravasation pocket. This critical step reduces the total concentration of the drug remaining in the tissue, potentially decreasing the severity of the subsequent chemical burn.