CRNI Infection Prevention and Control 2 — Questions and Answers

Question 1: What is the recommended frequency for assessing peripheral IV sites for signs of complications?

Once per shift
Every 1-2 hours for critically ill patients and at least every 4 hours for general patients (Correct answer)
Only when the patient reports discomfort
Every 8 hours during routine rounds

Correct answer: Every 1-2 hours for critically ill patients and at least every 4 hours for general patients

INS standards recommend IV site assessment every 1-2 hours for critically ill patients and vesicant/irritant infusions, and at least every 4 hours for stable patients.

The INS Standards of Practice mandate regular peripheral IV site assessments at intervals determined by patient acuity and infusion type. Critically ill patients, pediatric patients, and those receiving vesicant or irritant drugs require assessment every 1-2 hours. Stable adult patients receiving non-irritating infusions should be assessed at least every 4 hours. Assessment includes inspection for erythema, edema, drainage, catheter migration, and palpation for tenderness and induration. A standardized phlebitis scale should be used for documentation. Patient education about reporting pain, swelling, or changes at the IV site supplements but does not replace routine nursing assessment.

Question 2: Which practice is MOST important for preventing catheter-related infections during infusion therapy?

Using antibiotic prophylaxis during IV therapy
Maintaining a closed infusion system and minimizing line disconnections (Correct answer)
Changing IV tubing every 12 hours
This question is not relevant to infusion therapy

Correct answer: Maintaining a closed infusion system and minimizing line disconnections

Maintaining a closed system and minimizing unnecessary disconnections prevents microbial entry into the infusion system, which is the primary mechanism for intraluminal catheter colonization.

Maintaining a closed infusion system is fundamental to infection prevention in IV therapy. Every time the system is opened (for tubing changes, medication additions, or blood sampling), there is an opportunity for microbial contamination. Best practices include: using needleless connectors (properly disinfected before each access), minimizing unnecessary line disconnections, using closed blood sampling systems, consolidating medication administration times to reduce hub manipulations, and using pre-mixed IV solutions when available. Each additional manipulation of the catheter system has been associated with increased infection risk in multiple studies.

Question 3: What is the evidence-based practice for preventing bloodstream infections associated with midline catheters?

The same aseptic insertion technique used for peripheral IVs is sufficient
Modified Seldinger technique with maximum sterile barriers
Aseptic technique with CHG skin prep, similar to PICC insertion standards (Correct answer)
No specific guidelines exist for midline infection prevention

Correct answer: Aseptic technique with CHG skin prep, similar to PICC insertion standards

Midline catheter insertion requires aseptic technique with chlorhexidine skin antisepsis, reflecting the longer dwell time and deeper vessel placement compared to standard peripheral IVs.

Midline catheters (8-20 cm, tip in the upper arm vasculature) have an expected dwell time of 1-4 weeks, requiring higher-level infection prevention measures than standard peripheral IVs. INS Standards recommend: CHG skin antisepsis (same as for central lines), sterile technique during insertion (sterile gloves, drape, and no-touch technique), TSM dressing with date/time documentation, and regular site assessment. While maximum sterile barriers (as used for CVCs) are not universally required, many institutions apply similar standards given the extended dwell time. Post-insertion care mirrors PICC protocols including dressing changes every 5-7 days.

Question 4: Which environmental factor is MOST critical for safe IV admixture preparation?

Room temperature between 20-25 degrees C
ISO Class 5 air quality environment with proper aseptic technique (Correct answer)
Good natural lighting
Negative pressure room ventilation

Correct answer: ISO Class 5 air quality environment with proper aseptic technique

IV admixture preparation requires ISO Class 5 (formerly Class 100) air quality, typically achieved with a laminar airflow workbench, to minimize particulate and microbial contamination.

USP 797 mandates that compounding of sterile preparations, including IV admixtures, occurs in an ISO Class 5 environment (no more than 3,520 particles of 0.5 microns or larger per cubic meter of air). This is achieved using a primary engineering control such as a laminar airflow workbench (LAFW) or biological safety cabinet. The LAFW must be located within a buffer area of at least ISO Class 7 quality. The CRNI must understand these requirements to recognize when compounding conditions may compromise sterility. Beyond air quality, proper aseptic technique, gowning, hand hygiene, and surface disinfection are essential. Hazardous drug admixtures require additional containment (BSC or CACI).

Question 5: What is the recommended practice for flushing central venous catheters to maintain patency and prevent infection?

Continuous heparin infusion at 1 unit/mL
Pulsatile flush with preservative-free 0.9% NaCl using push-pause technique (Correct answer)
Flush only when the catheter appears occluded
Daily flush with 10 mL of bacteriostatic water

Correct answer: Pulsatile flush with preservative-free 0.9% NaCl using push-pause technique

Pulsatile flushing with preservative-free normal saline using a push-pause (start-stop) technique creates turbulence that effectively clears the catheter lumen of blood and fibrin.

The pulsatile (push-pause or start-stop) flush technique is recommended by INS for maintaining central venous catheter patency and reducing infection risk. This method involves alternately pushing and pausing 0.5-1 mL increments of preservative-free 0.9% NaCl, creating turbulent flow that dislodges fibrin and blood from the catheter walls more effectively than continuous laminar flow. The minimum flush volume should be twice the catheter and add-on device volume. Flushing should occur before and after each infusion or medication administration, after blood sampling, and at prescribed intervals for dormant lumens. Positive pressure must be maintained during disconnection to prevent blood reflux.

Question 6: Which surveillance measure is MOST useful for tracking infusion-related infections in a healthcare facility?

Monthly staff hand hygiene audits only
CLABSI rate per 1,000 central line days using NHSN definitions (Correct answer)
Tracking the total number of infections per year
Patient satisfaction surveys regarding IV care

Correct answer: CLABSI rate per 1,000 central line days using NHSN definitions

CLABSI rates standardized per 1,000 central line days using NHSN surveillance criteria allow meaningful comparison across units, facilities, and over time.

The National Healthcare Safety Network (NHSN) CLABSI rate (infections per 1,000 central line days) is the gold standard surveillance metric for infusion-related infections. This device-utilization ratio accounts for the duration of exposure, enabling meaningful comparisons between units, institutions, and national benchmarks. Calculation: (number of CLABSIs divided by total central line days) multiplied by 1,000. The NHSN definition requires specific criteria: laboratory-confirmed bloodstream infection in a patient with a central line (present more than 2 calendar days), with the infection not attributable to another site. Regular reporting, trend analysis, and benchmarking against NHSN percentiles drive quality improvement initiatives.

CRNI Infection Prevention and Control 2

What is the recommended frequency for assessing peripheral IV sites for signs of complications?