CRNI CRNI Peripheral Vascular Access and IV Site Management 5 — Questions and Answers
Question 1: A nurse inserts a peripheral IV catheter and notes blood return, but upon flushing encounters resistance followed by swelling at the site. What does this MOST likely indicate?
- Successful placement with normal tissue response
- Catheter tip against the vein wall
- Infiltration with the catheter in the subcutaneous tissue (Correct answer)
- Phlebitis at the insertion site
Correct answer: Infiltration with the catheter in the subcutaneous tissue
Swelling upon flushing despite initial blood return indicates infiltration, where the catheter tip has migrated out of the vein into surrounding subcutaneous tissue.
Question 2: Which antiseptic agent and technique is recommended by INS standards for peripheral IV site preparation in adults?
- 70% isopropyl alcohol, 15-second scrub, allowed to air dry
- 2% chlorhexidine gluconate in 70% isopropyl alcohol, back-and-forth friction scrub, allowed to dry completely (Correct answer)
- Povidone-iodine 10%, 30-second application, dried with sterile gauze
- Sterile normal saline, circular motion scrub outward from insertion site
Correct answer: 2% chlorhexidine gluconate in 70% isopropyl alcohol, back-and-forth friction scrub, allowed to dry completely
INS standards recommend a >0.5% chlorhexidine with alcohol solution (typically 2% CHG in 70% IPA) applied with friction and allowed to dry completely before catheter insertion.
Question 3: A patient with a peripheral IV on continuous infusion develops a fever. The IV site appears clean without erythema or tenderness. What is the CRNI's priority assessment?
- Immediately remove the IV catheter and culture the tip
- Assess for systemic signs of infection and evaluate the catheter as a potential source (Correct answer)
- Change the IV tubing and continue the infusion
- Administer antipyretics and reassess in 30 minutes
Correct answer: Assess for systemic signs of infection and evaluate the catheter as a potential source
Fever in a patient with a peripheral IV requires a systematic assessment to evaluate whether the catheter is a potential source of catheter-related bloodstream infection (CRBSI).
Question 4: When documenting a peripheral IV insertion per INS standards, which element is NOT required?
- Date and time of insertion
- Number of insertion attempts
- Patient's insurance information (Correct answer)
- Catheter gauge and length
Correct answer: Patient's insurance information
IV documentation must include date/time, gauge and length, site location, number of attempts, patient tolerance, and nurse identifier — insurance information is not a clinical documentation requirement.
Question 5: A patient states they are allergic to adhesive tape. What is the MOST appropriate securement method for a peripheral IV catheter?
- Use a transparent semipermeable membrane dressing without adhesive backing
- Secure with non-adhesive rolled gauze only
- Use a tissue-adherent catheter securement device or silicone-based tape alternative (Correct answer)
- Apply a thick layer of skin protectant barrier film, then standard adhesive tape
Correct answer: Use a tissue-adherent catheter securement device or silicone-based tape alternative
Engineered catheter securement devices (ECSDs) with tissue-adherent or silicone-based mechanisms provide secure catheter stabilization for patients with adhesive allergies.
Question 6: The nurse is caring for a patient whose peripheral IV catheter must be placed in the antecubital fossa due to poor vein access. Which intervention is MOST important to implement?
- Limit infusion to isotonic solutions only
- Apply an arm board to prevent flexion at the elbow (Correct answer)
- Change the site every 24 hours due to increased complication risk
- Use a 24-gauge catheter to reduce mechanical phlebitis
Correct answer: Apply an arm board to prevent flexion at the elbow
An arm board restricts elbow flexion that can occlude or dislodge a catheter placed in the antecubital fossa, reducing catheter failure from positional occlusion.
Question 7: Which finding would MOST strongly indicate a catheter-associated thrombosis in a patient with a peripheral IV in the forearm?
- Mild erythema at the insertion site only
- A palpable cord along the vein pathway proximal to the insertion site (Correct answer)
- Slight resistance when flushing the catheter
- A low-grade fever of 38°C (100.4°F) without local site changes
Correct answer: A palpable cord along the vein pathway proximal to the insertion site
A palpable cord along the vein proximal to the catheter insertion site is a hallmark sign of superficial thrombophlebitis or catheter-associated thrombosis requiring catheter removal.
CRNI CRNI Peripheral Vascular Access and IV Site Management 5
A nurse inserts a peripheral IV catheter and notes blood return, but upon flushing encounters resistance followed by swelling at the site.
What does this MOST likely indicate?