Sudden chest pain, dyspnea, hypotension, tachycardia, and anxiety suggest air embolism; clamp the line, place in left-side Trendelenburg, give oxygen, and call for help.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client with a fractured hip is on bed rest awaiting surgery. Which intervention BEST reduces the risk of venous thromboembolism?
Answer: B. Sequential compression devices (and/or prescribed anticoagulants) plus ankle pumps promote venous return and reduce stasis, lowering DVT/PE risk in an immobilized client. Massaging the calves is contraindicated because it can dislodge a clot.
Question 2 of 3
A nurse cares for a client with Guillain-Barre syndrome who is immobile and on bed rest. Which intervention is most important to prevent a common life-threatening complication?
Answer: B. Immobile clients with Guillain-Barre syndrome are at high risk for venous thromboembolism and pulmonary embolism. Sequential compression devices, prophylactic anticoagulation as ordered, and passive range of motion reduce this risk. Keeping the client flat without repositioning, restricting fluids, and avoiding all movement would increase complications.
Question 3 of 3
To prevent caregiver back injury when moving a client, the nurse should:
Answer: B. Use proper body mechanics and mechanical lifts/assist devices, get help, keep the load close, bend the knees, and avoid twisting. Lifting heavy clients alone risks injury.
Keep the streak going with more questions like these, each with a full rationale.
What is central venous catheter care?
Care centers on preventing central line-associated bloodstream infection (CLABSI) and air embolism. Key principle: maximal sterile technique on insertion, scrub the hub, and clamp before disconnecting.
Central Venous Catheter Care illustrated
Key points to remember
- The catheter tip sits in the superior vena cava; correct tip placement is confirmed by X-ray before initial use.
- Use sterile technique for dressing changes; a transparent dressing is changed every 7 days and gauze every 2 days, or when soiled/loose.
- Scrub the hub/needleless connector with alcohol or chlorhexidine for 15 seconds and allow to dry before each access.
- Flush with normal saline before and after use; some lines use a heparin lock per protocol (SAS or SASH method).
- Air embolism is prevented by clamping the lumen and using Valsalva (bear down) during tubing/cap changes.
- TPN and vesicants are given centrally because they are too hypertonic or caustic for peripheral veins.
Nursing priorities
- Perform sterile dressing changes on schedule and assess the site for redness, drainage, and tenderness.
- Scrub the hub and flush per protocol to maintain patency and prevent infection.
- Clamp the catheter and have the client perform Valsalva when changing caps or tubing.
- Position the client in left Trendelenburg if air embolism is suspected.
- Verify tip placement by X-ray before first use of a newly inserted line.
Labs & values
Patient teaching
- Keep the dressing clean, dry, and intact; report if it loosens or the site looks red or drains.
- Report fever, chills, chest pain, or shortness of breath immediately.
- Do not let the catheter get wet during bathing unless covered.
Red flags: report now
- Sudden chest pain, dyspnea, hypotension, tachycardia, and anxiety suggest air embolism; clamp the line, place in left-side Trendelenburg, give oxygen, and call for help.
- Fever, chills, or redness/drainage at the site suggests CLABSI; report and obtain cultures.
- Never leave a central line open to air; always clamp before disconnecting.
References
Clinical references for this topic
