A nurse is discontinuing a right subclavian non-tunneled central venous catheter for a client whose intravenous antibiotic therapy is complete. To minimize the risk of complications, in what order should the nurse perform the following actions?
- 1Position the client flat in a supine position.
- 2Instruct the client to take a deep breath and bear down.
- 3Withdraw the catheter smoothly in one continuous motion.
- 4Apply firm, direct pressure to the site with a sterile gauze pad.
- 5Inspect the distal tip of the removed catheter for intactness.
Cevap
The correct sequence is to position the client supine, instruct them to perform the Valsalva maneuver, withdraw the catheter, apply firm pressure to the site, and finally inspect the catheter tip.
Central venous catheter removal poses a significant risk for an air embolism because the intrathoracic pressure can drop below atmospheric pressure during inhalation, drawing air into the open vein. Placing the client in a supine position ensures the site is not elevated above the heart, increasing central venous pressure. Instructing the client to perform the Valsalva maneuver (bearing down) further raises intrathoracic pressure above atmospheric pressure. The catheter must be withdrawn precisely while this positive pressure is maintained. Immediately after removal, firm pressure is required to achieve hemostasis and physically block air entry. Finally, after the site is secure, inspecting the catheter tip ensures no fragments have embolized.
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Anahtar Kavram
The primary risks during central venous catheter removal are air embolism and bleeding. Nursing actions must follow a specific chronological sequence to maintain positive venous pressure and achieve hemostasis.
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