CRNI cheat sheet

Pre-infusion assessment includes verifying the order (drug, dose, route, rate, frequency), allergies, pertinent labs, vascular access patency, and baseline vital signs.

Phlebitis is graded on a 0–4 scale using pain, erythema, edema, induration, and palpable cord; grade 2 or higher generally requires catheter removal and restart at a new site.

Infiltration and extravasation assessment includes measuring limb circumference, marking erythema borders, and comparing with the opposite limb.

Daily weights should be obtained at the same time, on the same scale, with similar clothing; a 1-kg change approximates 1 L of fluid.

Teach-back confirms learning: the patient explains or demonstrates the information in their own words; re-teach until accurate.

Patients receiving home infusion need education on signs of infection, phlebitis, infiltration, occlusion, and when to call the provider.

Health literacy, preferred language, vision, hearing, and cognition determine the format and pace of patient education.

Central line site assessment includes cleanliness, dryness, intact dressing, absence of tenderness, erythema, drainage, or swelling.

Select the smallest gauge and shortest catheter that will accommodate the prescribed therapy; larger gauges are used for rapid resuscitation, blood products, and high-volume infusions.

The catheter should occupy less than 45% of the vein lumen to reduce thrombosis and phlebitis risk.

Avoid short peripheral IV placement in areas of flexion, the lower extremities in adults, and limbs with lymphedema, AV fistula, or mastectomy on the affected side.

PICC and central venous catheter tips should terminate in the lower third of the superior vena cava or at the cavoatrial junction; position is confirmed by imaging before use.

Central line insertion bundle: hand hygiene, maximal sterile barrier, chlorhexidine skin antisepsis, optimal site selection, and daily review of line necessity.

Transparent semipermeable dressings are changed every 5–7 days; gauze dressings every 2 days; any damp, loose, soiled, or nonocclusive dressing is changed immediately.

Disinfect needleless connectors with alcohol or chlorhexidine for 5–15 seconds and allow to dry before accessing the line.

Flush central catheters with a 10-mL or larger syringe using pulsatile flow and positive pressure to avoid catheter rupture and reflux.

Verify the right patient, drug, dose, route, time, and documentation; high-alert medications require an independent double check per policy.

Program infusion pumps using the drug library and confirm concentration, rate, dose, and volume to be infused before starting.

Do not assume compatibility: verify with a pharmacist or compatibility reference, and flush the line between incompatible medications.

For vesicants, confirm blood return before and during administration; stop immediately for pain, resistance, swelling, or loss of blood return.

Blood components are administered with 0.9% sodium chloride only, through a 170–260 micron filter, and must be completed within 4 hours of spiking.

Parenteral nutrition requires a dedicated lumen; lipids are infused separately or as a 3-in-1 admixture with a 1.2-micron filter.

Potassium chloride is never given by IV push; peripheral rates generally should not exceed 10 mEq/hr, and central rates require cardiac monitoring per protocol.

Document start and stop times, rate, volume, access site, patient response, and any adverse reactions.

Phlebitis: stop the infusion, remove the catheter, elevate the limb, apply a warm compress, document, and restart in a different site or limb.

Infiltration: stop the infusion, remove the catheter, elevate the limb, apply a cold compress unless protocol specifies warm for the infusate, and monitor.

Extravasation: stop the infusion, aspirate residual drug through the catheter, remove the catheter, apply the antidote and compress per protocol, and notify the provider.

Air embolism: place the patient in left lateral Trendelenburg position, administer 100% oxygen, and notify the provider immediately.

Catheter occlusion: never force flush; use a 10-mL syringe and follow protocol for thrombolytic (alteplase) or precipitate-dissolving agents.

Speed shock from rapid infusion causes flushing, headache, chest tightness, hypotension, and tachycardia; slow or stop the infusion and assess.

Fluid overload presents with dyspnea, crackles, jugular venous distention, edema, and weight gain; slow or stop the infusion and notify the provider.

An acute infusion reaction: stop the infusion, maintain the line with normal saline, assess, treat per protocol, and save the bag and tubing for analysis.

Perform hand hygiene before and after patient contact and after glove removal; use soap and water when hands are visibly soiled.

Use aseptic non-touch technique for every vascular access, including hub disinfection and sterile field maintenance.

CLABSI prevention includes insertion and maintenance bundles, daily necessity review, and prompt removal of unnecessary catheters.

Central line dressing changes require a sterile field, mask, and chlorhexidine-based antiseptic; allow the antiseptic to dry completely.

Do not recap needles; activate the safety device and dispose of sharps immediately in a puncture-resistant container at the point of use.

Hazardous drugs require NIOSH-recommended PPE: double chemotherapy gloves, gown, eye and face protection, and a closed system transfer device.

Neutropenic precautions include hand hygiene, avoiding fresh flowers and standing water, and screening visitors for illness.

Secure tubing and pumps to reduce falls and dislodgement; instruct ambulatory patients to use assistive devices and call for help.

Two qualified staff verify patient identity, blood type, unit number, component, and expiration at the bedside before transfusion.

Blood must be started within 30 minutes of arrival from the blood bank and completed within 4 hours.

Vital signs are obtained before transfusion, 15 minutes after starting, and per policy; a new fever, chills, dyspnea, or hypotension requires stopping the transfusion.

Use 0.9% sodium chloride as the only compatible IV fluid; never add medications to a blood component.

Platelets are stored at 20–24°C with continuous agitation and are never refrigerated.

Fresh frozen plasma is thawed and infused within 24 hours; ABO compatibility is required.

Transfusion reaction: stop the transfusion, keep the line open with saline, notify the provider and blood bank, return the bag and tubing, and send samples.

TACO (transfusion-associated circulatory overload) causes dyspnea, crackles, hypertension, and jugular venous distention; slow the rate and treat per order.

Parenteral nutrition is indicated when oral or enteral intake is inadequate for more than 7 days or the gastrointestinal tract cannot be used.

Central access is required for hypertonic PN solutions generally above 900 mOsm/L; peripheral PN must be lower osmolality.

Refeeding syndrome causes hypophosphatemia, hypokalemia, and hypomagnesemia; start nutrition slowly in severely malnourished patients and monitor electrolytes.

PN admixtures should be used within 24 hours, refrigerated until use, and never have medications added to the bag.

Lipid emulsions are checked for separation or a cream layer; if present, discard the emulsion.

Use a 1.2-micron filter for lipid-containing PN and a 0.22-micron filter for lipid-free PN.

Monitor daily weights, intake and output, glucose, electrolytes, triglycerides, and liver function tests during PN therapy.

Discontinue PN gradually to prevent rebound hypoglycemia; monitor glucose after stopping.

Dose formula: dose = (desired dose ÷ available dose) × volume; IV flow rate = volume ÷ time.

Drop rate: gtt/min = (volume in mL × drop factor) ÷ time in minutes.

Body surface area (Mosteller): BSA (m²) = square root of [(height in cm × weight in kg) ÷ 3600].

Corrected calcium = measured calcium + 0.8 × (4.0 − serum albumin in g/dL).

Sodium correction should not exceed 8–10 mEq/L in 24 hours, about 0.5 mEq/L/hr, to avoid osmotic demyelination.

Potassium chloride: never IV push; peripheral infusion generally 10 mEq/hr or less; central infusion up to 20 mEq/hr with continuous cardiac monitoring.

Hyperkalemia treatment includes calcium gluconate for cardiac stabilization, insulin with dextrose, albuterol, and potassium removal.

High-alert medications include insulin, heparin, opioids, chemotherapy, and concentrated electrolytes; use independent double checks.

Assess anxiety, fear of needles, body image concerns, financial strain, caregiver availability, and health literacy before planning education.

Needle phobia interventions include acknowledging fear, distraction, relaxation techniques, topical anesthetics, and positioning.

Home infusion readiness includes a safe environment, utilities, storage, caregiver capability, and an emergency communication plan.

Use qualified interpreters and culturally appropriate materials; involve family with the patient's permission.

Care coordination includes communication with the interdisciplinary team, home infusion pharmacy, and primary provider.

Social work referral can address insurance authorization, financial assistance, transportation, and home support.

Pediatric education uses developmentally appropriate language, play, and caregiver involvement.

Document patient preferences, goals of care, and advance directives in the plan.

The Infusion Nurses Society (INS) Infusion Therapy Standards of Practice is the primary evidence-based standard for infusion nursing.

Evidence hierarchy: systematic reviews and meta-analyses > randomized controlled trials > cohort studies > case-control studies > expert opinion.

Quality indicators include CLABSI rates, phlebitis, infiltration/extravasation, medication errors, and patient satisfaction.

Just culture encourages error reporting while maintaining accountability for reckless behavior.

Scope of practice is defined by the state nurse practice act, institutional policy, and validated competency.

Root cause analysis is used for sentinel events to identify system failures and prevent recurrence.

Policy and procedure reviews should be evidence-based, scheduled, and documented.

Certification maintenance requires continuing education and adherence to professional standards.