CRNI Managing Infusion Complications 5 — Questions and Answers
Question 1: A nurse notices that a patient's IV infusion has been running into the subcutaneous tissue for an unknown period. The infiltrated solution was D10W. Which local complication is the primary concern?
- Chemical phlebitis
- Tissue necrosis from hyperosmolar solution (Correct answer)
- Systemic hyperglycemia
- Catheter-related bloodstream infection
Correct answer: Tissue necrosis from hyperosmolar solution
Hyperosmolar solutions such as D10W can cause tissue necrosis when infiltrated into subcutaneous tissue due to osmotic damage to local cells.
Question 2: During a lipid infusion via a peripheral IV, a patient develops a fever, chest and back pain, and dyspnea. Which rare but serious complication should the nurse suspect?
- Fat overload syndrome (Correct answer)
- Pulmonary embolism from catheter thrombus
- Anaphylaxis to soy-based lipid emulsion
- Speed shock from rapid infusion
Correct answer: Fat overload syndrome
Fat overload syndrome is a rare complication of lipid emulsions presenting with fever, hepatosplenomegaly, coagulopathy, and pulmonary symptoms caused by impaired lipid clearance.
Question 3: A patient with a tunneled central catheter develops pain, erythema, and warmth along the subcutaneous tunnel tract. What complication does this indicate?
- Exit-site infection
- Tunnel infection (Correct answer)
- Port pocket infection
- Catheter-related bloodstream infection
Correct answer: Tunnel infection
Erythema, warmth, and tenderness extending more than 2 cm along the subcutaneous tunnel tract beyond the exit site is diagnostic of a tunnel infection.
Question 4: What is the recommended nursing action when a patient receiving IV potassium chloride reports severe burning and pain at the peripheral IV site with no other abnormal findings?
- Discontinue the infusion and restart at a new site
- Dilute the solution further and reduce the infusion rate (Correct answer)
- Apply a warm compress over the IV site and continue at current rate
- Switch to a central access device and continue therapy
Correct answer: Dilute the solution further and reduce the infusion rate
Potassium chloride is a chemical irritant; reducing the concentration and slowing the rate often relieves burning while maintaining the same access site when no extravasation is present.
Question 5: A postoperative patient receiving a continuous peripheral nerve block infusion suddenly develops confusion, metallic taste, tinnitus, and perioral numbness. What is the most likely cause?
- Opioid toxicity from concurrent IV analgesia
- Local anesthetic systemic toxicity (LAST) (Correct answer)
- Hypoglycemia from poor oral intake
- Air embolism from catheter displacement
Correct answer: Local anesthetic systemic toxicity (LAST)
Metallic taste, tinnitus, perioral numbness, and CNS symptoms are classic early signs of local anesthetic systemic toxicity (LAST) due to intravascular absorption.
Question 6: Which factor most significantly increases a patient's risk for developing catheter-associated thrombosis in a peripherally inserted central catheter (PICC)?
- Use of the basilic vein for insertion
- Catheter-to-vein ratio greater than 45% (Correct answer)
- Infusion of isotonic crystalloids
- Flushing with normal saline every 8 hours
Correct answer: Catheter-to-vein ratio greater than 45%
A catheter-to-vein ratio exceeding 45% impedes blood flow around the catheter, creating turbulence and stasis that significantly increase thrombosis risk.
Question 7: A nurse is caring for a patient whose implanted port needle has dislodged during a vesicant infusion, resulting in extravasation into the port pocket. What is the most important immediate nursing intervention?
- Reaccess the port with a new needle and flush to confirm placement
- Stop the infusion, leave the needle in place, and notify the provider immediately (Correct answer)
- Remove the needle, apply a pressure dressing, and document the incident
- Aspirate residual drug through the dislodged needle and remove it
Correct answer: Stop the infusion, leave the needle in place, and notify the provider immediately
Stopping the infusion immediately while leaving the needle in place preserves the ability to aspirate residual vesicant and allows the provider to assess the extent of extravasation.
CRNI Managing Infusion Complications 5
A nurse notices that a patient's IV infusion has been running into the subcutaneous tissue for an unknown period.
The infiltrated solution was D10W.
Which local complication is the primary concern?