A nurse is performing a tubing change on a client's central venous catheter. The client suddenly gasps, reports severe chest pain, and exhibits acute dyspnea. Suspecting an air embolism, arrange the following nursing actions in the correct priority order from first to last.
- 1Clamp the central venous catheter.
- 2Place the client in a left lateral Trendelenburg position.
- 3Apply 100% oxygen via a non-rebreather face mask.
- 4Activate the rapid response team.
Answer
The correct sequence of actions for a suspected air embolism is to first clamp the catheter, then position the client on their left side with the head lower than the feet, followed by administering high-flow oxygen, and finally activating the rapid response team.
When an air embolism is suspected during a central line procedure, the nurse must immediately stop the source by clamping the catheter. Next, positioning the client in a left lateral Trendelenburg position traps the air in the right ventricle, preventing it from entering the pulmonary artery. Administering oxygen is the next priority to treat hypoxia and shrink the nitrogen bubble. Finally, escalating care by activating the rapid response team ensures advanced medical support.
Step-by-Step Solution
Key Concept
Immediate mitigation of a suspected air embolism involves stopping the air entry and properly positioning the client before seeking further medical assistance.
Estimated Time:1m 0s