CRNI Vascular Access Device Management Questions and Answers 1 — Questions and Answers
Question 1: A patient with a peripherally inserted central catheter (PICC) in the right basilic vein reports sudden, sharp pain at the insertion site during a bolus infusion of a vesicant medication. The nurse notes swelling and coolness to the touch proximal to the site. Which of the following is the MOST appropriate initial nursing action?
- Stop the infusion immediately and disconnect the tubing. (Correct answer)
- Slow the infusion rate and apply a warm compress.
- Administer an analgesic and continue to monitor the site.
- Flush the line with normal saline to check for patency.
Correct answer: Stop the infusion immediately and disconnect the tubing.
The patient's signs and symptoms—sudden pain, swelling, and coolness—are classic indicators of extravasation, the inadvertent administration of a vesicant solution into the surrounding tissue. The first and most critical action is to stop the infusion immediately to prevent further damage. Disconnecting the tubing prevents any additional medication from entering the tissue.
Question 2: When selecting a vein for peripheral intravenous catheter insertion in an adult patient, which principle is most critical for preserving future vascular access?
- Choosing the most visible and easily palpable vein.
- Using the patient's dominant arm for convenience.
- Selecting a site in the antecubital fossa for stability.
- Starting with the most distal, appropriate site in the non-dominant arm. (Correct answer)
Correct answer: Starting with the most distal, appropriate site in the non-dominant arm.
The Infusion Nurses Society (INS) standards of practice recommend selecting the most distal site in the non-dominant arm that is appropriate for the prescribed therapy. This approach, known as vein preservation, saves more proximal sites for future cannulation if needed, which is crucial for patients who may require long-term or repeated IV therapy.
Question 3: A nurse is unable to aspirate a blood return from a non-tunneled central venous catheter that has been infusing total parenteral nutrition (TPN) without issue. What is the most likely cause of this finding?
- The catheter has migrated into the extravascular space.
- A fibrin sheath has formed around the catheter tip. (Correct answer)
- The patient is severely dehydrated.
- The TPN solution has clotted the entire catheter lumen.
Correct answer: A fibrin sheath has formed around the catheter tip.
A persistent withdrawal occlusion, or the inability to aspirate blood despite the ability to infuse fluids, is often caused by the formation of a fibrin sheath at the catheter's tip. This sheath acts as a one-way valve, allowing fluid to be pushed out but collapsing over the catheter opening during aspiration. While other causes are possible, this is a very common complication.
Question 4: Which of the following is a key maintenance step for reducing the risk of a central line-associated bloodstream infection (CLABSI)?
- Performing routine dressing changes every 24 hours.
- Flushing all lumens with heparinized saline daily.
- Administering prophylactic antibiotics before accessing the line.
- Scrubbing the access hub vigorously for at least 5-15 seconds prior to each use. (Correct answer)
Correct answer: Scrubbing the access hub vigorously for at least 5-15 seconds prior to each use.
Vigorous scrubbing of the needleless connector or 'hub' with an appropriate antiseptic (e.g., chlorhexidine, 70% alcohol) and allowing it to dry is a critical evidence-based practice to prevent intraluminal contamination and subsequent CLABSI. The friction and contact time are essential to disinfect the surface effectively before accessing the line.
Question 5: A patient with an implanted port is scheduled for a monthly infusion. Upon accessing the port with a non-coring needle, the nurse meets resistance and is unable to flush the device. Which of the following complications should the nurse suspect?
- Catheter-related bloodstream infection.
- Catheter migration.
- Thrombotic occlusion. (Correct answer)
- Pinch-off syndrome.
Correct answer: Thrombotic occlusion.
The inability to flush an implanted port that was previously functional often indicates a thrombotic occlusion, where a blood clot has formed within the catheter or port reservoir, blocking the flow. This is a common cause of catheter malfunction. While other issues like migration or pinch-off can cause resistance, thrombosis is a primary consideration.
Question 6: A nurse is assessing a short peripheral catheter site and notes blanching, edema, and skin that is cool to the touch around the insertion point. The IV pump is not alarming. The nurse should identify these findings as signs of what complication?
- Phlebitis
- Infection
- Infiltration (Correct answer)
- Hematoma
Correct answer: Infiltration
Infiltration occurs when non-vesicant IV solution leaks into the surrounding tissue. The classic signs include localized edema, skin blanching (paleness), and coolness due to the room-temperature fluid in the subcutaneous tissue. The pump may not alarm if the flow is not significantly restricted.
CRNI Vascular Access Device Management Questions and Answers 1
A patient with a peripherally inserted central catheter (PICC) in the right basilic vein reports sudden, sharp pain at the insertion site during a bolus infusion of a vesicant medication.
The nurse notes swelling and coolness to the touch proximal to the site.
Which of the following is the MOST appropriate initial nursing action?