During a routine tubing replacement for a continuous total parenteral nutrition (TPN) infusion, a client's central venous catheter (CVC) accidentally disconnects at the hub. The client immediately exhibits air hunger, profound cyanosis, and reports sharp, severe chest pain. Hemodynamic monitoring reveals a sudden tachycardic rate of and a blood pressure plummeting to . Which action should the nurse execute first?
- Clamp the catheter and position the client in the left lateral Trendelenburg position.Cevap
- BRaise the head of the bed to a high-Fowler's position to immediately facilitate respiratory effort.
- CDirect an unlicensed assistive personnel (UAP) to initiate oxygen therapy while securing the line.
- DAuscultate the anterior chest to identify a mill-wheel murmur before proceeding with interventions.
Cevap
Clamp the catheter and position the client in the left lateral Trendelenburg position.
The clinical presentation strongly indicates a venous air embolism, a life-threatening complication of central venous catheters. The immediate priority is to stop further air from entering the circulatory system by clamping the open catheter. Following this, the client must be placed 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 and right ventricle, preventing it from migrating into the pulmonary artery and causing right ventricular outflow tract obstruction.
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Anahtar Kavram
Management of Venous Air Embolism in Central Venous Catheters