A nurse is removing a central venous catheter from a client's subclavian vein. Immediately after the catheter is withdrawn, the client suddenly gasps for air, reports sharp chest pain, and becomes severely dyspneic and pale. Suspecting an air embolism, arrange the following nursing actions in the priority order they should be performed to reduce the risk of a fatal cardiopulmonary complication.
- 1Apply a sterile occlusive dressing firmly over the insertion site.
- 2Place the client in the left lateral Trendelenburg position.
- 3Administer 100% oxygen via a non-rebreather mask.
- 4Activate the rapid response system and notify the healthcare provider.
- 5Initiate continuous monitoring of vital signs and oxygen saturation.
Answer
The correct priority sequence is: first, apply a sterile occlusive dressing; second, position the client in the left lateral Trendelenburg position; third, administer 100% oxygen; fourth, activate the rapid response system; and finally, initiate continuous monitoring.
In the event of a suspected air embolism during central line removal, the nurse's immediate goal is risk reduction through sequential mechanical and physiological interventions. Applying an occlusive dressing stops further air entrainment. The left lateral Trendelenburg position then traps the air in the right ventricle, preventing a catastrophic pulmonary artery occlusion. High-flow oxygen is administered to treat tissue hypoxia and accelerate nitrogen resorption from the embolus. Only after these immediate, life-saving bedside steps are taken should the nurse activate the rapid response team, followed by continuous hemodynamic monitoring to evaluate the client's status.
Step-by-Step Solution
Key Concept
Emergency management and risk reduction of a central line-associated air embolism.