Fundamentals of Nursing Q 291
A nurse is caring for a client who disconnected the tubing of the parenteral nutrition from the central line catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate position for the client in this kind of situation?
A. On the right side, with head higher than the feet.
B. On the right side, with head lower than the feet.
C. On the left side, with the head higher than the feet.
D. On the left side, with head lower than the feet.
Correct Answer: D. On the left side, with head lower than the feet.
Air embolism happens because of the entry of air into the catheter system. If it occurs, the client should be placed in a left-side-lying position with the head be lower than the feet. This position will lessen the effect of the air traveling as a bolus to the lungs by trapping it on the right side of the heart. It occurs as a result of a pressure gradient that allows air to enter the bloodstream, which can subsequently occlude blood flow.
Option A: When removing catheters, it is also recommended to raise CVP by keeping the patient in a supine position or with their head down or Trendelenburg position. Ideally, the venotomy site should be below the level of the heart to ensure adequate central venous pressure at the time of removal.
Option B: Patients should be instructed to perform a Valsalva maneuver during catheter removal, if possible. If this is not possible, removing the catheter during active expiration is recommended. It should be ensured that the exit site is covered with impermeable dressing and that pressure is applied afterward for 5–10 min, for hemostasis and prevention of bubble entry. It is recommended that the patient remains supine for 30 min after central venous access removal
Option C: In cases of venous air embolism, Durant’s maneuver is performed, by placing the patient in the left lateral decubitus and Trendelenburg position. This serves to encourage the air bubble to move out of the right ventricular outflow tract (RVOT) and into the right atrium, thereby relieving the “air-lock” effect responsible for potentially catastrophic cardiopulmonary collapse.