A nurse is preparing to remove a client's non-tunneled central venous catheter (CVC). After performing hand hygiene, donning appropriate personal protective equipment (PPE), and removing the old dressing, in what order should the nurse perform the following actions? Arrange the steps from first to last.
- 1Position the client in a flat, supine or slight Trendelenburg position.
- 2Instruct the client to take a deep breath, hold it, and bear down.
- 3Withdraw the catheter smoothly and steadily in one continuous motion.
- 4Apply firm pressure to the exit site with sterile gauze.
- 5Secure an airtight, occlusive dressing over the insertion site.
Cevap
The correct sequence for removing a central venous catheter is to first position the client appropriately (supine or Trendelenburg), instruct them to perform the Valsalva maneuver, withdraw the catheter during the maneuver, immediately apply firm pressure to the site, and finally secure an occlusive dressing.
This sequence systematically minimizes the risk of air embolism and bleeding. Proper positioning and the Valsalva maneuver create positive pressure in the central veins prior to removal. Immediate pressure and an occlusive dressing ensure the venous tract remains sealed from the atmosphere after the catheter is removed.
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Anahtar Kavram
Safe removal of a central venous catheter requires meticulous interventions to prevent air embolism, a life-threatening complication caused by air entering the central circulation.