A clinical nurse is preparing to discontinue a non-tunneled central venous access device (CVAD) located in the right internal jugular vein of an adult client. To minimize the risk of a venous air embolism and promote physiological integrity, in what order should the nurse execute these interventions? Arrange the steps in the correct chronological sequence.
- 1Position the client flat in a supine position.
- 2Instruct the client to take a deep breath, hold it, and bear down.
- 3Withdraw the catheter smoothly and continuously.
- 4Apply firm, continuous manual pressure to the insertion site with sterile gauze.
- 5Secure an airtight, petroleum-based occlusive dressing over the site.
Cevap
The correct sequence for CVAD removal minimizes the risk of air embolism by manipulating intrathoracic pressure and securing the site: position supine, initiate Valsalva maneuver, withdraw the catheter, apply firm pressure, and finally secure an occlusive dressing.
Central venous access device removal carries a high risk for venous air embolism due to the potential for negative intrathoracic pressure to draw air into the open vein. The correct sequence systematically eliminates this risk: supine positioning raises central venous pressure; the Valsalva maneuver creates a positive pressure gradient; withdrawing the catheter during this positive pressure ensures air is repelled; applying immediate manual pressure achieves hemostasis; and sealing the site with a petroleum-based occlusive dressing prevents air entry through the unhealed tissue tract.
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Anahtar Kavram
Prevention of venous air embolism during central venous access device (CVAD) removal