A nurse is removing a central venous access device (CVAD) from a client's right subclavian vein. During the procedure, the client suddenly gasps for air, becomes profoundly dyspneic, and exhibits perioral cyanosis. The client's blood pressure drops to 72/40 mm Hg, and a loud 'churning' murmur is auscultated over the precordium. Arrange the following emergency nursing interventions in the correct physiological sequence from first to last.
- 1Immediately apply direct pressure over the central line insertion site using a sterile, occlusive dressing.
- 2Place the client in a left lateral Trendelenburg position (Durant's maneuver).
- 3Administer high-flow 100% oxygen via a non-rebreather mask.
- 4Activate the rapid response system and notify the primary healthcare provider.
- 5Prepare the client for advanced hemodynamic support and potential echocardiography.
Cevap
The correct sequence is to first immediately seal the insertion site to prevent further air entry, then place the client in the left lateral Trendelenburg position to trap the embolus, followed by administering 100% oxygen to shrink the bubble, activating the rapid response team, and finally preparing for advanced interventions.
The correct sequence prioritizes immediate source control (sealing the site) to prevent further harm, followed immediately by anatomical positioning (left lateral Trendelenburg) to prevent the fatal migration of the air embolus into the pulmonary artery. Once the embolus is contained, high-flow oxygen is administered to treat hypoxemia and reduce the bubble's size. Finally, summoning advanced help and preparing for definitive diagnostic procedures completes the emergency response.
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Anahtar Kavram
Venous Air Embolism Emergency Management