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Difficulty: HardPhysiological Adaptation

A nurse enters the room of a client receiving total parenteral nutrition via a right subclavian central venous catheter. The nurse discovers that the intravenous tubing has completely disconnected from the catheter hub. The client is suddenly extremely anxious, gasping for air, and cyanotic, with a rapidly dropping blood pressure. Arrange the following emergency nursing actions in the priority sequence they should be performed. (Place the most immediate priority action at the top).

  1. 1Clamp the central venous catheter immediately.
  2. 2Place the client in a left lateral Trendelenburg position.
  3. 3Administer 100% oxygen via a non-rebreather mask.
  4. 4Activate the rapid response team and notify the healthcare provider.
  5. 5Assess vital signs and prepare for hemodynamic support.

Answer

The correct emergency sequence is to first clamp the catheter to stop the source of the air leak, then position the client in the left lateral Trendelenburg position to trap the embolus, administer high-flow oxygen to treat hypoxia, activate the rapid response team for emergency assistance, and finally monitor hemodynamics to prepare for advanced support.
The priority in managing a central venous air embolism is to immediately stop the source of air entrainment by clamping the disconnected catheter. Following this, positioning the client in the left lateral Trendelenburg position (Durant's maneuver) is critical because it utilizes gravity to trap the air bubble in the apex of the right ventricle, preventing it from migrating into the pulmonary artery and causing obstructive shock. Once the physical source and anatomical risks are mitigated, applying 100% oxygen treats the resulting hypoxia and accelerates the resorption of nitrogen gas from the embolus. After these immediate life-saving actions are complete, the nurse must activate the rapid response team to escalate care, followed by continuous assessment and preparation of vasopressors to manage ongoing hemodynamic instability.

Step-by-Step Solution

1
Clamp the central venous catheter immediately.
Halts the continuous entry of room air into the central venous system.
Addressing the immediate source of the crisis prevents the air embolus from expanding and causing further physiological collapse.
2
Place the client in a left lateral Trendelenburg position.
Displaces the intravascular air bubble away from the pulmonary valve.
Gravity forces the lighter air to rise into the apex of the right atrium and right ventricle, preventing a fatal right ventricular outflow tract obstruction into the pulmonary circulation.
3
Administer 100% oxygen via a non-rebreather mask.
Maximizes alveolar oxygen concentration.
Reverses profound tissue hypoxia and creates a diffusion gradient that pulls nitrogen out of the trapped air embolus, accelerating its resorption.
4
Activate the rapid response team and notify the healthcare provider.
Mobilizes critical care providers and advanced resuscitation equipment.
Definitive medical intervention and potential transfer to an intensive care unit are required immediately after independent nursing actions are completed.
5
Assess vital signs and prepare for hemodynamic support.
Establishes baseline clinical parameters post-intervention.
Identifies profound obstructive shock that may require immediate vasopressor administration or fluid volume resuscitation.

Key Concept

Management of Central Venous Air Embolism and Obstructive Shock
Estimated Time:2m 0s
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Topics

Physiological Adaptation

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