The nurse is caring for a patient following insertion of a left subclavian central venous catheter ( CVC ).Which assessment finding 2 hours after insertion by the nurse warrants immediate action?
A) Diminished breath sounds over left lung field
B) Localized pain at catheter insertion site
C) Measured central venous pressure of 5 mm Hg
D) Slight bloody drainage around insertion site

Question

Quizplus · Accepted Answer

Diminished breaths sounds over the lung field on the same side of the line insertion site may be indicative of a pneumothorax.A pneumothorax,which can develop slowly,is a major complication following insertion of central lines when the subclavian route is used.Localized pain at catheter insertion site is not the immediate priority in this scenario.A measured central venous pressure of 5 mm Hg is normal.Slight bloody drainage at the insertion site soon after the procedure does not require immediate action.

The Nurse Is Caring for a Patient Following Insertion of a Left