# A nurse is caring for a patient with a central venous catheter (CVC) who develops signs of a catheter-related bloodstream infection (CRBSI). Which nursing intervention should be implemented first?

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> subject: Next Gen NCLEX

## 문제

A nurse is caring for a patient with a central venous catheter (CVC) who develops signs of a catheter-related bloodstream infection (CRBSI). Which nursing intervention should be implemented first?

The nurse notices increased temperature, chills, and purulent drainage at the CVC insertion site.

## 보기

1. Obtain blood cultures from both the CVC and a peripheral vein
2. Remove the central venous catheter immediately
3. Notify the healthcare provider immediately **✔ 정답**
4. Administer prescribed antibiotics through the CVC

**정답: 3**

## 해설

Notify the healthcare provider immediately for prompt medical evaluation and treatment decisions, as CRBSI requires coordinated care. Other interventions depend on provider orders.

## 심화 해설

Clinical Scenario Analysis

The patient is exhibiting classic signs of a catheter-related bloodstream infection (CRBSI): elevated temperature, chills, and purulent drainage at the insertion site. In the NCLEX-RN framework, when a patient presents with an acute change in status, the first step is always to assess and communicate findings to the primary decision-maker—in this case, the healthcare provider (HCP)—before implementing independent or dependent interventions that could alter the diagnostic picture or require a new order.

Why Not the Other Options?

1.  Obtain blood cultures from both the CVC and a peripheral vein — This is a critical step in the diagnostic workup for CRBSI, but it is an intervention that requires a provider’s order. Performing this before notifying the HCP delays definitive diagnosis and treatment decisions. Furthermore, drawing cultures after antibiotics have been started can yield false-negative results, so the sequence of communication, culture, and then antibiotics is vital.

2.  Remove the central venous catheter immediately — While catheter removal is often the definitive treatment for CRBSI, it is not an independent nursing action. The decision to remove a CVC must be made by the HCP, who will weigh the risks and benefits, especially if the line is critical for ongoing therapy. Premature removal without an order is outside the nurse’s scope of practice. Research underscores that CVCs are a significant source of infection in critically ill patients, making proper management, not independent removal, the nurse's role [1].

3.  Notify the healthcare provider immediately — This is the correct first action. The nurse has gathered assessment data (fever, chills, purulent drainage) that indicates a serious, acute complication. The nurse’s immediate responsibility is to communicate these findings to the HCP so that a comprehensive treatment plan, which may include orders for cultures, catheter removal, and antibiotics, can be initiated. This aligns with the nursing role in preventing adverse outcomes from central line-associated bloodstream infections (CLABSI), which hinges on strict adherence to protocols and prompt communication [2].

4.  Administer prescribed antibiotics through the CVC — This action is contraindicated on two fronts. First, the CVC is the suspected source of the infection; infusing antibiotics through it would deliver the drug directly into a potentially colonized line, reducing its efficacy and possibly seeding more bacteria into the bloodstream. Standard practice for CRBSI involves obtaining cultures and often removing the line before administering antibiotics through a new, uninfected peripheral site. Second, even if antibiotics were appropriate, the nurse must first notify the HCP of the new findings to receive the correct order, as the current prescription may not cover the specific pathogens involved.

Pathophysiology and Clinical Reasoning

A CRBSI occurs when microorganisms colonize the external or internal surface of the catheter, leading to bacteremia. The purulent drainage at the exit site is a localized sign of this colonization, while the fever and chills indicate a systemic inflammatory response to circulating pathogens. In critically ill patients, the risk of CRBSI is influenced by multiple factors, including the duration of catheterization and the implementation of preventive care bundles [1,3]. The nurse’s role is to recognize these early signs, halt any potential ongoing interventions that could worsen the situation (like using the line for infusions), and immediately escalate the situation to the provider. This rapid escalation is the cornerstone of preventing the increased morbidity, extended hospital stays, and higher mortality associated with CLABSI [2]. The diagnostic process, including paired blood cultures to confirm the catheter as the source, must follow the initial communication to ensure it is performed correctly and in the right sequence [4].

## 임상 시나리오

Suspected CRBSI: Initial Nursing ActionPrioritize communication before invasive interventions
When a patient with a central venous catheter (CVC) develops signs of infection such as fever, chills, or purulent drainage, the nurse's first action is to notify the healthcare provider (HCP). This respects the scope of practice, as subsequent diagnostic tests and catheter removal require a provider's order.

CautionDo not draw blood cultures after starting antibiotics, as this can cause false-negative results. The correct sequence is notification, then cultures, then antibiotics. Never remove a CVC without an order.

## 핵심 개념

- **CRBSI** — Catheter-Related Bloodstream Infection, a serious infection confirmed by matching cultures from the catheter and a peripheral vein.
- **CVC** — Central Venous Catheter, a line inserted into a large vein for medication, fluids, or monitoring.
- **Nursing Priority** — The sequence of actions based on assessment, often starting with notifying the provider of critical changes.
- **Scope of Practice** — Actions a nurse is legally permitted to perform, distinguishing independent from dependent interventions.

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