CRNI CRNI Peripheral Vascular Access and IV Site Management 4 — Questions and Answers
Question 1: A patient receiving a vesicant via peripheral IV begins to complain of burning and the nurse notes swelling at the site. What is the FIRST action the nurse should take?
- Stop the infusion and disconnect the IV tubing
- Aspirate any remaining drug before removing the catheter (Correct answer)
- Apply a warm compress to the site
- Notify the physician immediately
Correct answer: Aspirate any remaining drug before removing the catheter
When extravasation of a vesicant is suspected, the nurse should stop the infusion and attempt to aspirate residual drug from the catheter before removal to minimize tissue damage.
Question 2: Which gauge peripheral IV catheter is MOST appropriate for a rapid blood transfusion in an adult patient?
- 24 gauge
- 22 gauge
- 20 gauge
- 18 gauge (Correct answer)
Correct answer: 18 gauge
An 18-gauge catheter is preferred for blood transfusions requiring rapid infusion because its larger lumen accommodates higher flow rates without hemolysis.
Question 3: What is the maximum recommended dwell time for a peripheral IV catheter in adults according to INS standards?
- 48 hours
- 72 hours
- 96 hours
- No set time limit if site is without complications (Correct answer)
Correct answer: No set time limit if site is without complications
INS 2021 standards recommend removing peripheral IV catheters based on clinical indication rather than a routine time-based replacement schedule, provided the site shows no signs of complications.
Question 4: A nurse is assessing a peripheral IV site and notes a PICC score of 2 (slight tenderness, no erythema). What is the appropriate intervention?
- Continue monitoring and reassess in 1 hour
- Remove the catheter and resite in the opposite extremity (Correct answer)
- Apply topical antibiotic ointment and continue infusion
- Increase the infusion rate to prevent clot formation
Correct answer: Remove the catheter and resite in the opposite extremity
A VIP (Visual Infusion Phlebitis) or phlebitis score of 2 indicates early phlebitis and warrants removal of the catheter and resiting at a new location.
Question 5: Which anatomical site is CONTRAINDICATED for peripheral IV insertion in most adult patients?
- Forearm cephalic vein
- Antecubital fossa basilic vein
- Hand dorsal metacarpal veins
- Lower extremity foot veins (Correct answer)
Correct answer: Lower extremity foot veins
Lower extremity veins are generally contraindicated for peripheral IV access in adults due to the high risk of thrombophlebitis and deep vein thrombosis.
Question 6: When calculating osmolarity to determine if a solution can safely run through a peripheral IV, what is the upper osmolarity threshold for peripheral administration?
- 450 mOsm/L
- 600 mOsm/L (Correct answer)
- 900 mOsm/L
- 1200 mOsm/L
Correct answer: 600 mOsm/L
Solutions with osmolarity greater than 600 mOsm/L carry a high risk of causing phlebitis and should be administered via a central venous catheter rather than a peripheral IV.
Question 7: A patient's peripheral IV site shows no signs of infiltration or phlebitis, but the IV has not infused for the past 2 hours despite a patent-appearing site. What is the MOST likely cause?
- Catheter occlusion due to fibrin sheath formation
- Positional occlusion of the catheter tip (Correct answer)
- Medication precipitation in the tubing
- Air embolism in the IV line
Correct answer: Positional occlusion of the catheter tip
Positional occlusion occurs when movement of the patient's arm or wrist kinks or compresses the catheter tip, causing flow to stop without visible infiltration or phlebitis.
CRNI CRNI Peripheral Vascular Access and IV Site Management 4
A patient receiving a vesicant via peripheral IV begins to complain of burning and the nurse notes swelling at the site.
What is the FIRST action the nurse should take?