A nurse is preparing to discontinue a client's non-tunneled central venous catheter (CVC) from the internal jugular vein. In what order should the nurse perform the following actions to minimize the risk of complications? Arrange the steps in the correct sequence from first to last.
- 1Position the client flat in a supine position.
- 2Remove the current dressing and release any securement devices.
- 3Instruct the client to take a deep breath, hold it, and bear down.
- 4Withdraw the catheter in a smooth, continuous motion.
- 5Apply a sterile, occlusive dressing immediately over the insertion site.
Answer
The correct sequence is: position the client supine, remove the dressing and securements, instruct the client to perform the Valsalva maneuver, withdraw the catheter, and immediately apply a sterile occlusive dressing.
Removing a central venous catheter carries a high risk of air embolism. The proper sequence of actions is designed to manipulate intrathoracic and venous pressure to prevent air from entering the central circulation. The client must first be positioned supine to increase central venous pressure. After preparing the site by removing securements, the client performs the Valsalva maneuver to create positive intrathoracic pressure. The catheter must be withdrawn precisely during this maneuver, and the site is immediately sealed with an occlusive dressing to prevent air entry through the open tissue tract.
Step-by-Step Solution
Key Concept
Safe removal of a central venous catheter requires meticulous technique focused on preventing air embolism, primarily achieved through supine positioning, the Valsalva maneuver, and immediate application of an occlusive dressing.