A nurse is preparing to remove a client's non-tunneled central venous catheter (CVC). To reduce the risk of a potentially fatal air embolism, in what order should the nurse perform the following actions? Arrange the steps from first to last.
- 1Place the client in a flat, supine or slight Trendelenburg position.
- 2Instruct the client to take a deep breath and bear down (Valsalva maneuver).
- 3Withdraw the catheter smoothly and continuously.
- 4Apply immediate pressure with an occlusive dressing over the insertion site.
Cevap
First position the client supine, then instruct them to perform the Valsalva maneuver, withdraw the catheter smoothly, and finally apply an occlusive dressing.
Removing a central venous catheter carries a high risk of air embolism if atmospheric air enters the central circulation. To reduce this risk, the nurse must manipulate pressure dynamics. First, placing the client in a supine or Trendelenburg position naturally increases central venous pressure. Second, having the client perform the Valsalva maneuver creates positive intrathoracic pressure, effectively blocking air from entering. Third, the catheter is withdrawn while this positive pressure is maintained. Finally, immediately applying an occlusive (air-tight) dressing seals the skin tract, preventing any subsequent air entry once the client resumes normal breathing.
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Anahtar Kavram
Central Venous Catheter Removal Safety Protocol