A nurse is changing the intravenous (IV) tubing for a client receiving continuous total parenteral nutrition (TPN) via a central venous catheter. The catheter hub is accidentally left unclamped during the tubing exchange. The client suddenly gasps, reports sharp chest pain, and becomes severely dyspneic, pale, and tachycardic. Which of the following is the priority nursing action?
- AElevate the head of the bed to a high Fowler's position to facilitate lung expansion.
- Clamp the catheter and place the client in the left lateral Trendelenburg position.Cevap
- CImmediately flush the central venous catheter with of sterile normal saline.
- DInstruct the client to bear down using the Valsalva maneuver while continuing the tubing change.
Cevap
The priority action is to clamp the catheter and position the client in the left lateral Trendelenburg position.
The client's sudden onset of sharp chest pain, dyspnea, and tachycardia immediately following exposure of an unclamped central line hub strongly indicates an air embolism. The immediate priority is to stop further air entry by clamping the catheter and to place the client in the left lateral Trendelenburg position (on their left side with the head lower than the feet). This specific position utilizes gravity to trap the air bubble in the apex of the right atrium or right ventricle, preventing it from migrating into the pulmonary circulation and causing a catastrophic right ventricular outflow obstruction.
Adım Adım Çözüm
Anahtar Kavram
Air Embolism Management in Central Venous Catheters