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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central venous catheter (CVC). During an intravenous tubing change, the client suddenly grasps their chest and reports severe shortness of breath. The client's oxygen saturation drops rapidly to 85%. Suspecting a central line-associated air embolism, which of the following immediate actions should the nurse take? (Select all that apply.)

  1. Clamp the central venous catheter immediately.Answer
  2. B
    Position the client in a high-Fowler's position to facilitate respiratory expansion.
  3. Place the client in the left lateral Trendelenburg position.Answer
  4. D
    Administer a prescribed intravenous analgesic directly into the dedicated TPN port.
  5. Administer 100% oxygen via a non-rebreather mask.Answer
  6. F
    Delegate the collection of immediate vital signs to the unlicensed assistive personnel (UAP).

Answer

The correct actions include clamping the central venous catheter, placing the client in the left lateral Trendelenburg position, and administering 100% oxygen.
An air embolism is a life-threatening complication of parenteral therapies involving central venous access devices. The immediate priorities are to stop further air entry by clamping the line, prevent the existing air from migrating to the pulmonary circulation by placing the client in the left lateral Trendelenburg position, and treat hypoxia while facilitating nitrogen resorption by applying high-flow oxygen.

Step-by-Step Solution

1
Identify the complication based on the clinical presentation.
The combination of a central line tubing change, sudden chest pain, and severe hypoxia strongly indicates a central line-associated air embolism.
Air embolism is a known critical risk when a central venous system is opened to atmospheric pressure.
2
Stop the source of the air leak.
The central venous catheter is immediately clamped.
Clamping the catheter prevents any further atmospheric air from being drawn into the central venous circulation.
3
Reposition the client to trap the air.
The client is placed in the left lateral Trendelenburg position (Durant's maneuver).
This positioning utilizes gravity to keep the air embolus suspended in the right atrium or right ventricle, preventing it from occluding the pulmonary circulation.
4
Address the resulting hypoxemia and promote air resorption.
High-flow oxygen (100%) is administered via a non-rebreather mask.
Oxygen treats the immediate hypoxia and creates a nitrogen gradient that accelerates the resorption of the air bubble.

Key Concept

Management of Central Line-Associated Air Embolism
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Topics

Pharmacological and Parenteral Therapies

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