Final answer:
If there's no blood return in an IV line before giving mechlorethamine, check for patency and signs of extravasation, and assess for circulatory shock. If unresolved, remove and replace the IV line, and stabilize the patient before administering the drug.
Step-by-step explanation:
When a nurse notes a loss of blood return via a 24-gauge peripheral line before administering mechlorethamine, immediate assessments must include checking for peripheral intravenous (IV) line patency and ensuring there is no infiltration or extravasation. The absence of blood return may indicate the IV line is not properly seated within the vein or that there is a clot at the tip of the catheter. Immediate actions should involve stopping the infusion and attempting to flush the line with a saline solution. If the line cannot be restored to proper functioning, it should be removed and a new line should be established before administering any medication, especially a vesicant like mechlorethamine, which can cause severe tissue damage if it leaks into surrounding tissues.
An assessment for circulatory shock symptoms such as low blood pressure, rapid heart rate, and decreased urine output is crucial because mechlorethamine administration requires stable circulatory function. In the context of the patient's medical condition and characteristics of the peripheral line, if signs of shock are present, it would be unsafe to proceed with administration until the patient is stabilized. Medical intervention may include fluids or medication to manage shock, and a central line may be considered if peripheral access is compromised and mechlorethamine therapy is still indicated.