CRNI Managing Infusion Complications Questions and Answers 1 — Questions and Answers
Question 1: A patient with a newly placed non-tunneled central venous catheter in the subclavian vein suddenly becomes dyspneic, hypotensive, and tachycardic during an IV tubing change. The CRNI suspects an air embolism. What is the PRIORITY nursing intervention?
- Administer high-flow oxygen via a non-rebreather mask.
- Immediately obtain a stat portable chest x-ray.
- Place the patient in the Trendelenburg position on their left side. (Correct answer)
- Place the patient in a high-Fowler's position to ease breathing.
Correct answer: Place the patient in the Trendelenburg position on their left side.
The immediate priority for a suspected venous air embolism is to trap the air in the apex of the right ventricle to prevent it from moving into the pulmonary artery and obstructing outflow. Placing the patient on their left side in the Trendelenburg position (Durant's maneuver) accomplishes this. While administering oxygen and obtaining imaging are important subsequent actions, initial life-saving positioning is the first priority.
Question 2: A CRNI is assessing a peripheral IV site and notes pain at the access site, erythema, streak formation, and a palpable venous cord measuring approximately 1 inch. According to the Infusion Nurses Society (INS) Phlebitis Scale, how should the nurse grade this finding?
- Grade 2
- Grade 3 (Correct answer)
- Grade 1
- Grade 4
Correct answer: Grade 3
The INS Phlebitis Scale grades severity based on specific clinical signs. The presence of pain, erythema, streak formation, AND a palpable venous cord corresponds to a Grade 3 finding. Grade 2 involves pain, erythema, and/or edema but lacks the palpable cord or streak. Grade 4 includes all the signs of Grade 3 plus purulent drainage.
Question 3: A nurse is administering an IV push medication rapidly. The patient suddenly complains of a severe headache, dizziness, and a 'fluttering' feeling in their chest. The patient appears flushed and becomes hypotensive. The CRNI should recognize these symptoms as characteristic of which systemic infusion complication?
- Anaphylactic reaction
- Circulatory overload
- Speed shock (Correct answer)
- Pyrogenic reaction
Correct answer: Speed shock
Speed shock is a systemic reaction caused by the rapid infusion of a substance into the circulation, leading to toxic plasma levels. Classic symptoms include dizziness, headache, facial flushing, irregular pulse (fluttering), and can progress to hypotension, shock, and cardiac arrest. It is directly related to the rate of administration.
Question 4: During a routine dressing change for a patient's PICC line, the CRNI notes that the external catheter length has increased by 4 cm compared to the documented insertion length. The patient also reports occasionally hearing a 'gurgling' sound in their ear on the side of the catheter insertion. Which of the following is the most likely complication?
- Catheter fracture
- Venous thrombosis
- Pinch-off syndrome
- Catheter migration (Correct answer)
Correct answer: Catheter migration
An increase in the measured external length of a central line is a primary indicator of catheter migration. Symptoms such as a gurgling sound in the ear can suggest that the catheter tip has moved into the jugular vein. The infusion should be stopped and tip position must be confirmed via chest x-ray before further use.
Question 5: A patient with a peripheral IV complains of sudden, sharp pain radiating up their arm during the infusion of a room-temperature antibiotic. The infusion has slowed significantly despite no signs of infiltration or phlebitis. Which action is most appropriate to manage a suspected venous spasm?
- Apply a warm compress to the vein above the insertion site. (Correct answer)
- Increase the infusion rate to push past the spasm.
- Apply a cold compress to the area.
- Re-site the catheter in a larger vein immediately.
Correct answer: Apply a warm compress to the vein above the insertion site.
A venous spasm is a sudden constriction of the vein, often caused by the administration of cold infusates, irritating solutions, or a rapid flow rate. The primary management is to decrease the flow rate and apply a warm compress to the area to promote vasodilation and relieve the spasm. Applying a cold compress would worsen vasoconstriction.
Question 6: A CRNI is caring for a patient whose central venous access device (CVAD) is determined to have a thrombotic occlusion after mechanical causes have been ruled out. Which intervention is the standard of care for this complication?
- Flushing the catheter with a 10 mL syringe using forceful pressure.
- Replacing the entire central venous access device.
- Instilling 0.1 N hydrochloric acid into the catheter.
- Administering a thrombolytic agent like alteplase per institutional protocol. (Correct answer)
Correct answer: Administering a thrombolytic agent like alteplase per institutional protocol.
For a confirmed intraluminal thrombotic occlusion (clot), the standard of care is the administration of a thrombolytic (fibrinolytic) agent, such as alteplase (Cathflo Activase), according to evidence-based guidelines and institutional policy. Hydrochloric acid is used for certain drug precipitates, forceful flushing can dislodge the clot or damage the catheter, and replacement is a last resort.
CRNI Managing Infusion Complications Questions and Answers 1
A patient with a newly placed non-tunneled central venous catheter in the subclavian vein suddenly becomes dyspneic, hypotensive, and tachycardic during an IV tubing change.
The CRNI suspects an air embolism.
What is the PRIORITY nursing intervention?