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Zorluk: ZorPharmacological and Parenteral Therapies

A client receiving parenteral nutrition via a right subclavian central venous access device (CVAD) suddenly reports severe chest pain, shortness of breath, and a feeling of impending doom. The nurse observes that the intravenous tubing has become disconnected from the catheter hub. Which of the following immediate interventions should the nurse implement? (Select all that apply.)

  1. Clamp the central venous catheter immediately.Cevap
  2. Position the client on their left side with the head of the bed lower than the feet.Cevap
  3. Administer 100% oxygen via a non-rebreather mask.Cevap
  4. D
    Elevate the head of the bed to a high-Fowler's position.
  5. E
    Obtain a stat arterial blood gas (ABG) sample before initiating further actions.
  6. F
    Auscultate bilateral lung fields to confirm the diagnosis prior to clamping the line.

Cevap

The nurse must immediately clamp the central venous catheter, position the client in a left lateral Trendelenburg position, and administer 100% oxygen.
The client is exhibiting classic signs of a venous air embolism, a life-threatening complication of central venous access devices when the system is opened to atmospheric pressure. The immediate priorities are to stop further air entry by clamping the line, trap the existing air in the right atrium by placing the client in the left lateral Trendelenburg position (preventing it from entering the pulmonary artery), and correct hypoxia by administering 100% oxygen.

Adım Adım Çözüm

1
Identify the clinical emergency based on the presentation.
The client's sudden chest pain, dyspnea, feeling of impending doom, and the disconnected CVAD hub indicate a high probability of a venous air embolism.
Air can rapidly enter the central circulation through an open central venous catheter because intrathoracic pressure is lower than atmospheric pressure.
2
Stop the source of air entry.
Clamping the catheter prevents any further air from being drawn into the venous system.
Securing the line is the absolute first priority to minimize the total volume of the air embolism.
3
Reposition the client strategically.
Placing the client in a left lateral Trendelenburg position (Durant's maneuver) traps the air in the right atrium and the apex of the right ventricle.
This specific positioning prevents the air bubble from entering the pulmonary artery and blocking right ventricular outflow, which would lead to obstructive shock and cardiac arrest.
4
Support oxygenation and hemodynamics.
Administering 100% oxygen is initiated to treat the resulting hypoxia.
High-concentration oxygen not only treats hypoxemia but also promotes the reabsorption of nitrogen from the air bubble, helping to shrink the embolus over time.

Anahtar Kavram

Venous Air Embolism Management in Parenteral Therapies
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Konular

Pharmacological and Parenteral Therapies

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