CRNI Managing Infusion Complications 4 — Questions and Answers
Question 1: A patient receiving a vesicant chemotherapy agent through a peripheral IV reports burning and the nurse observes no blood return and swelling at the site. What is the priority nursing action?
- Slow the infusion rate and reassess in 15 minutes
- Stop the infusion immediately and aspirate residual drug if possible (Correct answer)
- Apply a warm compress and elevate the extremity
- Flush the line with normal saline to confirm patency
Correct answer: Stop the infusion immediately and aspirate residual drug if possible
When vesicant extravasation is suspected, the infusion must be stopped immediately and residual drug aspirated before removing the catheter to minimize tissue damage.
Question 2: A patient develops chills, rigors, and a temperature of 39.8°C within 30 minutes of starting an infusion. Which complication is most consistent with these findings?
- Phlebitis
- Speed shock
- Catheter-related bloodstream infection (CRBSI) (Correct answer)
- Air embolism
Correct answer: Catheter-related bloodstream infection (CRBSI)
Sudden onset of fever, chills, and rigors during infusion are classic signs of catheter-related bloodstream infection or infusion-related sepsis.
Question 3: When grading phlebitis using a standard scale, which finding corresponds to Grade 3 phlebitis?
- Pain at access site with no erythema
- Pain with erythema and/or edema at access site
- Pain with erythema, streak formation, and palpable venous cord (Correct answer)
- Pain with erythema, streak formation, palpable cord, and purulent drainage
Correct answer: Pain with erythema, streak formation, and palpable venous cord
Grade 3 phlebitis is characterized by pain with erythema, streak formation, and a palpable venous cord greater than 1 inch in length.
Question 4: A central venous catheter patient suddenly develops dyspnea, hypotension, and a mill-wheel murmur. Which complication does this presentation indicate?
- Pneumothorax
- Air embolism (Correct answer)
- Catheter occlusion
- Thrombosis
Correct answer: Air embolism
A mill-wheel murmur combined with dyspnea and hypotension is pathognomonic for venous air embolism, caused by air entering the central venous system.
Question 5: Which intervention is correct when a nurse suspects air embolism in a patient with a central venous catheter?
- Elevate the head of the bed to 45 degrees and call a rapid response
- Place the patient in left lateral Trendelenburg position and clamp the catheter (Correct answer)
- Remove the catheter immediately and apply pressure
- Administer high-flow oxygen and continue the infusion at a slower rate
Correct answer: Place the patient in left lateral Trendelenburg position and clamp the catheter
Left lateral Trendelenburg (Durant's maneuver) traps air in the right ventricle apex, preventing it from entering the pulmonary vasculature, while clamping prevents further air entry.
Question 6: A nurse is assessing a patient's PICC line and notes resistance when flushing and an inability to aspirate blood. Which type of occlusion is most likely?
- Thrombotic occlusion
- Mechanical occlusion due to tip malposition
- Precipitate occlusion from drug incompatibility
- Fibrin tail occlusion (Correct answer)
Correct answer: Fibrin tail occlusion
A fibrin tail occlusion (also called a ball-valve or one-way occlusion) allows flushing but blocks aspiration because the fibrin flap acts as a one-way valve.
Question 7: Alteplase (tPA) is ordered to restore patency to an occluded central venous catheter. What is the recommended dwell time before attempting to aspirate and clear the catheter?
- 5–10 minutes
- 15–30 minutes
- 30–120 minutes (Correct answer)
- 4–6 hours
Correct answer: 30–120 minutes
The standard protocol for alteplase catheter clearance involves instilling the drug and allowing a dwell time of 30–120 minutes before aspiration, per INS and manufacturer guidelines.
CRNI Managing Infusion Complications 4
A patient receiving a vesicant chemotherapy agent through a peripheral IV reports burning and the nurse observes no blood return and swelling at the site.
What is the priority nursing action?