A practical nurse (PN) is caring for a client with a central venous catheter (CVC). Upon entering the room, the PN discovers that the intravenous tubing has accidentally disconnected from the CVC hub. The client is suddenly dyspneic, coughing, and appears cyanotic. Suspecting a central line air embolism, in what order should the PN implement the following actions? Arrange the steps from first to last.
- 1Clamp the exposed central venous catheter immediately.
- 2Place the client on their left side with the head of the bed lowered.
- 3Activate the facility's rapid response system.
- 4Administer high-flow supplemental oxygen via a non-rebreather mask.
- 5Obtain a complete set of vital signs and pulse oximetry.
Cevap
The correct sequence is to first clamp the catheter, position the client in a left lateral Trendelenburg position, activate the rapid response system, administer oxygen, and finally obtain vital signs.
In a suspected central line air embolism, the absolute first step is source control: clamping the catheter to prevent further air entry. Second, the client must be placed in Durant's maneuver (left lateral decubitus with Trendelenburg) to trap the air bubble in the apex of the right ventricle, keeping it away from the pulmonary outflow tract. Third, the nurse must activate the rapid response system to mobilize advanced help. Fourth, administering 100% oxygen treats ischemia and helps reduce the size of the air embolus by promoting nitrogen washout. Finally, obtaining vital signs provides essential baseline data for the arriving emergency team.
Adım Adım Çözüm
Anahtar Kavram
Emergency Management of a Central Venous Catheter Air Embolism