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Difficulty: MediumPharmacological and Parenteral Therapies

During a routine intravenous (IV) tubing change for a client's central venous catheter (CVC), the catheter hub accidentally becomes disconnected and is left open to room air. The client abruptly gasps for breath, begins coughing violently, and reports acute, sharp chest pain. The client's lips appear cyanotic and oxygen saturation drops to 81%. What is the priority nursing action?

  1. Clamp the catheter immediately and place the client in a left lateral Trendelenburg position.Answer
  2. B
    Elevate the head of the bed to high-Fowler's position and apply 100% oxygen via a non-rebreather mask.
  3. C
    Auscultate bilateral lung sounds and obtain a comprehensive set of vital signs to determine the degree of hypoxia.
  4. D
    Administer a prescribed as-needed (PRN) dose of intravenous epinephrine, suspecting an acute anaphylactic reaction.

Answer

The correct action is to immediately clamp the catheter and position the client in a left lateral Trendelenburg position.
Clamping the catheter immediately stops further air entry. Placing the client in a left lateral Trendelenburg position is the standard emergency medical intervention for an air embolism, as it traps the air in the right ventricle and prevents it from occluding the pulmonary circulation.

Step-by-Step Solution

1
Identify the complication.
Recognize that an open central venous catheter hub accompanied by sudden, severe respiratory distress indicates a life-threatening air embolism.
Air rapidly enters the venous system due to negative intrathoracic pressure during inspiration.
2
Stop the source.
Clamp the central venous catheter.
Clamping the line instantly prevents any additional air from being drawn into the client's central circulation.
3
Position the client appropriately.
Place the client in the left lateral Trendelenburg position.
This specific position utilizes gravity to trap the air bubble in the apex of the right ventricle, preventing it from migrating forward into the pulmonary artery and causing a right ventricular outflow tract obstruction.

Key Concept

Management of Central Venous Catheter Complications (Air Embolism)
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Topics

Pharmacological and Parenteral Therapies

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