Comprehensive Nursing Pharmacology Q 291
What volume of air can safely be infused into a patient with a central venous access device (CVAD)?
A. It is dependent on the patient’s weight and height.
B. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems.
C. It is dependent on comorbidities such as asthma or chronic obstructive lung disease.
D. None.
Correct Answer: D. None.
Any air entering the right heart can lead to a pulmonary embolism. All air should be purged from central venous lines; none should enter the patient. In order to avoid air embolism, the patient should be placed in the Trendelenburg position at all times during insertion to increase venous pressure. Additionally, all catheter hubs should be occluded at all times.
Option A: Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Significant morbidity and mortality can result from complications related to central venous access.
Option B: Air embolism can occur during catheter insertion or inadvertently when flushing the catheter. Negative intrathoracic pressure from inspiration can draw air into the vein while cannulized, and hypoxia can result from larger air emboli that reach the pulmonary arterial system. If an air embolism is suspected, the patient should be placed on high flow oxygen and in the left lateral decubitus position. The left lateral decubitus position localizes air to the right atrium and right lung and prevents further air emboli from entering the pulmonary artery.
Option C: These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal.