A nurse is caring for a client with a central venous access device (CVAD) that is completely occluded. The healthcare provider has prescribed alteplase to declot the line. Arrange the following steps for administering this thrombolytic agent in the correct chronological sequence. All steps must be used.
- 1Assess the catheter for mechanical obstruction by attempting to aspirate blood and flush with 0.9% sodium chloride.
- 2Instill the prescribed dose of alteplase into the occluded lumen using a negative-pressure technique.
- 3Allow the thrombolytic solution to dwell inside the catheter lumen for 30 to 120 minutes.
- 4Aspirate the medication and dissolved clot remnants until 4 to 5 mL of blood is returned.
- 5Vigorously flush the cleared catheter lumen with 10 to 20 mL of sterile 0.9% sodium chloride.
Cevap
The correct sequence is to first assess for mechanical obstruction, then instill the alteplase using negative pressure, allow it to dwell for 30 to 120 minutes, aspirate the drug and clot, and finally flush the restored line with normal saline.
Safe administration of a thrombolytic for CVAD clearance requires a specific sequence to protect the patient from emboli and systemic bleeding. The nurse must first confirm the occlusion, use negative pressure to safely draw the drug into the lumen, allow sufficient dwell time for fibrinolysis, aspirate the dissolved clot and medication to prevent systemic administration, and finally flush with saline to clear the line.
Adım Adım Çözüm
Anahtar Kavram
Management of Central Venous Access Device (CVAD) Occlusion