Which action is most important to prevent catheter-related bloodstream infection?

Rationale:
A. Phlebitis is incorrect because phlebitis is localized inflammation of the vein and presents with redness, warmth, pain, and a palpable cord along the vein. It does not cause dyspnea or crackles in the lungs.

B. Fluid volume overload is correct because sudden dyspnea, crackles on auscultation, and possibly tachycardia or hypertension are classic signs of pulmonary congestion from excess IV fluid. This is especially likely if fluids are infused too rapidly or in patients with cardiac or renal compromise. Immediate nursing actions include slowing or stopping the infusion, elevating the head of the bed, administering oxygen, and notifying the provider.

C. Air embolism is incorrect because an air embolism typically presents with sudden chest pain, hypotension, tachycardia, dyspnea, and sometimes a “mill wheel” murmur. While dyspnea occurs, crackles are not a characteristic finding of air embolism.

D. Infiltration is incorrect because infiltration involves leakage of IV fluid into surrounding tissue, leading to coolness, pallor, swelling, and discomfort at the insertion site, not pulmonary symptoms like dyspnea or crackles.

Rationale:

A. Change IV tubing every 24 hours is incorrect because current evidence-based guidelines recommend changing IV tubing according to type of fluid and facility policy, often every 72 hours for continuous infusions or every 24 hours for blood products or TPN, not automatically every 24 hours. While tubing changes help reduce infection risk, hand hygiene is more fundamental.

B. Flush the IV catheter frequently is incorrect because flushing helps maintain line patency and prevents medication interactions, but it does not directly prevent bloodstream infections unless done as part of aseptic technique.

C. Perform hand hygiene before and after IV care is correct because hand hygiene is the single most effective method to prevent catheter-related bloodstream infections (CRBSIs). Contaminated hands are a primary source of pathogens introduced during catheter insertion, medication administration, or line manipulation. Proper hand hygiene reduces microbial transmission and protects both patient and healthcare provider.

D. Wear gloves during insertion is incorrect because while sterile gloves are required during insertion, gloves alone cannot prevent infection if hand hygiene is neglected. Gloves are a barrier, but contamination can still occur if hands are not clean before gloving or if aseptic technique is broken.