A nurse is preparing to remove a non-tunneled central venous catheter (CVC) from a client's right subclavian vein. Arrange the following nursing actions in the correct sequential order to safely remove the catheter and reduce the risk of an air embolism. (Place the first action at the top and the final action at the bottom.)
- 1Place the client in a supine position with the head of the bed flat.
- 2Instruct the client to take a deep breath, hold it, and bear down.
- 3Withdraw the catheter smoothly and swiftly from the insertion site.
- 4Apply immediate, firm pressure to the site using a sterile gauze pad.
- 5Apply an occlusive dressing over the site and inspect the catheter tip.
Cevap
The correct sequence for removing a central venous catheter to minimize risk is: position the client supine, instruct the client to perform the Valsalva maneuver, withdraw the catheter during the maneuver, apply immediate firm pressure, and finally secure the site with an occlusive dressing while verifying catheter intactness.
Removing a central venous catheter carries a high risk of air embolism and bleeding. The safest physiological approach is to maximize central venous pressure before and during the procedure. This is achieved by placing the client flat (supine) and having them perform the Valsalva maneuver. The catheter is removed while the client bears down to prevent air from entering the tract. Immediately after removal, firm pressure is applied to achieve hemostasis, followed by the application of an airtight occlusive dressing to protect the site while the tract heals. Finally, inspecting the catheter tip ensures no fragments have broken off into the client's circulation.
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Anahtar Kavram
Prevention of Air Embolism during Central Venous Catheter Removal