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Difficulty: MediumReduction of Risk Potential

A nurse is preparing to discontinue a client's non-tunneled central venous catheter (CVC) located in the right subclavian vein. To minimize the risk of a potential air embolism, arrange the following nursing actions in the correct physiological sequence. (Place the first action at the top and the final action at the bottom.)

  1. 1Position the client flat in bed (supine) or in a slight Trendelenburg position.
  2. 2Instruct the client to take a deep breath and bear down (Valsalva maneuver).
  3. 3Withdraw the catheter smoothly and continuously while the client bears down.
  4. 4Apply immediate, firm pressure to the insertion site using sterile gauze.
  5. 5Apply a sterile, occlusive dressing over the site.

Answer

1. Position the client flat in bed (supine) or in a slight Trendelenburg position.
2. Instruct the client to take a deep breath and bear down (Valsalva maneuver).
3. Withdraw the catheter smoothly and continuously while the client bears down.
4. Apply immediate, firm pressure to the insertion site using sterile gauze.
5. Apply a sterile, occlusive dressing over the site.
Removing a central venous catheter carries a high risk of an air embolism, which can be fatal. The nurse must systematically manipulate pressure gradients to keep air out of the venous system. First, placing the client supine or in Trendelenburg increases central venous pressure at the site. Second, instructing the client to bear down (the Valsalva maneuver) creates positive intrathoracic pressure. Third, actually removing the catheter during this positive pressure phase ensures air cannot enter the exposed tract. Fourth, applying immediate manual pressure physically seals the tract and achieves hemostasis. Finally, securing an occlusive (air-tight) dressing provides a long-term barrier against air entry while the skin and venous tract heal over the subsequent days.

Step-by-Step Solution

1
Ensure the client is in a supine or slight Trendelenburg position.
The insertion site is positioned below or at the level of the heart.
This increases central venous pressure and reduces the immediate risk of an air embolism.
2
Ask the client to perform the Valsalva maneuver.
Intrathoracic pressure momentarily spikes.
This creates positive pressure inside the vessel, preventing outside air from being sucked in when the catheter is removed.
3
Remove the central venous catheter.
The catheter is fully withdrawn from the subclavian vein.
This is performed during the Valsalva maneuver to ensure continuous positive intrathoracic pressure during the vulnerable moment of removal.
4
Apply immediate pressure with sterile gauze.
Bleeding is controlled and the tract is physically sealed.
Immediate pressure prevents air from entering the open tract before a permanent dressing is applied.
5
Secure a sterile, occlusive dressing.
The site is sealed airtight.
An occlusive dressing blocks air from entering the healing tract over the next 24 to 72 hours.

Key Concept

Central Venous Catheter Removal and Air Embolism Prevention
Estimated Time:1m 30s
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Topics

Reduction of Risk Potential

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