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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is preparing to discontinue a client's non-tunneled central venous catheter (CVC) located in the right subclavian vein. Place the following nursing actions in the correct chronological order to ensure safe removal and prevent complications.

  1. 1Position the client flat in a supine position.
  2. 2Instruct the client to take a deep breath, hold it, and bear down.
  3. 3Withdraw the catheter in a smooth, continuous motion.
  4. 4Apply immediate, firm pressure to the site with a sterile gauze pad.
  5. 5Secure an air-tight, occlusive dressing over the insertion site.

Answer

The correct sequence is: Position the client supine, instruct them to perform the Valsalva maneuver, withdraw the catheter smoothly, apply immediate firm pressure, and finally secure an occlusive dressing.
Following this specific chronological sequence ensures that the intrathoracic pressure remains higher than atmospheric pressure during the exact moment the vein is exposed. This effectively prevents air from entering the central circulation. Subsequent immediate pressure and the application of an occlusive dressing maintain hemostasis and provide an airtight seal.

Step-by-Step Solution

1
Position the client flat in a supine position.
Central venous pressure is increased.
Lowering the head of the bed prevents negative pressure in the central veins, which is the primary mechanism that can draw air into the circulation.
2
Instruct the client to take a deep breath, hold it, and bear down.
Intrathoracic pressure is temporarily maximized.
The Valsalva maneuver ensures that pressure inside the chest is higher than atmospheric pressure, providing a protective barrier against air embolism during catheter removal.
3
Withdraw the catheter in a smooth, continuous motion.
The catheter is removed safely.
Smooth removal prevents catheter breakage and must occur while the patient is actively maintaining the Valsalva maneuver.
4
Apply immediate, firm pressure to the site with a sterile gauze pad.
Hemostasis is achieved and the tract is manually sealed.
Immediate pressure stops venous bleeding and acts as a physical barrier to air until the tract can be dressed.
5
Secure an air-tight, occlusive dressing over the insertion site.
The insertion site is protected from air and infection.
An occlusive dressing prevents delayed air entry through the residual catheter tract while the tissue heals over the next 24 to 72 hours.

Key Concept

Safe removal of a central venous catheter requires meticulous interventions to increase central venous pressure and prevent a potentially fatal air embolism.
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Topics

Pharmacological and Parenteral Therapies

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