The nurse working in an intensive care unit receives a prescription from the primary health care provider to discontinue a triple-lumen subclavian central venous catheter. Which interventions will help prevent air embolism on removal? Select all that apply. A)Applying an air-occlusive dressing B)Instructing the client to bear down C)Instructing the client to lie in a supine position D)Pulling the line harder if there is resistance E)Pulling the line out when the client is inhaling

Question

Quizplus · Accepted Answer

To prevent air embolism when discontinuing a central venous catheter, the nurse should perform the following interventions: Instruct the client to lie in a supine position. This will increase the central venous pressure and decrease the possibility of air getting into the vessel (Option C). Instruct the client to bear down or exhale. The client should never inhale during removal of the line; inhalation will suck more air into the blood vessel via negative suction pressure (Options B and E). Apply an air-occlusive dressing (usually gauze with a Tegaderm dressing) to help prevent a delayed air embolism. If possible, the nurse should attempt to cover the site with the occlusive dressing while pulling out the line (Option A). Pull the line cautiously and never pull harder if there is resistance. Doing so could cause the catheter to break or become dislodged in the client's vessel (Option D). Educational objective: To prevent air embolism when discontinuing a central venous catheter, it is important for the nurse to pull the line cautiously, have the client in a supine position, have the client bear down or exhale, and apply an air-occlusive dressing.

The Nurse Working in an Intensive Care Unit Receives a Prescription