NORCERT 8 Mains-2025
Medical & Surgical Nursing
Medium
In a conscious and stable patient, what instructions should be given while removing the central venous catheter to minimize complications?
Appeared in: NORCERT 8 Mains-2025
Explanation
- The Valsalva maneuver involves taking a deep breath and holding it, which significantly increases the pressure inside the chest (intrathoracic pressure).
- This elevated pressure is transmitted to the central veins, raising the venous pressure above atmospheric pressure.
- This positive pressure gradient is crucial because it prevents air from being sucked into the open vein tract as the catheter is withdrawn.
- Preventing air entry into the central circulation effectively minimizes the risk of a potentially life-threatening air embolism.
Why Other Options Were Wrong
- Option B: This is a correct nursing action performed before the procedure, not a patient instruction given during the procedure. The question specifically asks for instructions to the patient.
- Option C: Forceful exhalation (without a closed glottis) decreases intrathoracic pressure, creating a negative pressure gradient that increases the risk of air being sucked into the vein.
- Option D: Drinking water is irrelevant to the physiological mechanisms needed to prevent an air embolism and introduces an unnecessary risk of aspiration.
Related Visual
- Visual 1: Diagram - An illustration showing how the Valsalva maneuver increases intrathoracic pressure, compressing the heart and great vessels, thereby increasing central venous pressure.
- Visual 2: Infographic - A step-by-step guide for safe CVC removal, highlighting key actions: 1. Patient positioning (Trendelenburg/supine), 2. Patient instruction (Valsalva), 3. Catheter withdrawal, 4. Application of occlusive dressing.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Prevention of Air Embolism during Central Venous Catheter (CVC) Removal to guide bedside assessment, documentation, and the next nursing action.
- Air embolism is a rare but potentially fatal complication of CVC removal. The nurse's role in providing clear instructions and using the correct technique is a critical patient safety measure.
- After removal, the nurse must immediately apply an air-occlusive dressing, assess the catheter tip for intactness, and monitor the patient for signs of respiratory distress (e.g., dyspnea, chest pain, cyanosis), which could indicate an air embolism.
- What if the patient is unconscious or on a mechanical ventilator? In this case, the patient cannot perform a Valsalva maneuver. The nurse should time the removal to coincide with the end of inspiration or the expiratory phase of the ventilator cycle, when intrathoracic pressure is at its highest.
How to Approach the Question
- Identify the core clinical procedure: Removal of a central venous catheter.
- Recall the most significant, acute risk associated with this procedure: Air embolism.
- Analyze the specific question being asked: What instruction should be given to the patient? This requires differentiating between nursing actions (like positioning) and patient actions (like breathing maneuvers).
- Evaluate each option based on its physiological effect on intrathoracic and central venous pressure.
- Select the option that describes a patient-driven action that increases intrathoracic pressure, thereby preventing air from entering the vein.
- Recognize that placing the patient in Trendelenburg is a correct nursing action but not a patient instruction, making it a strong but incorrect distractor for this specific question.
Concept Tested & Keywords
- Concept Tested: Prevention of Air Embolism during Central Venous Catheter (CVC) Removal
- Stem keywords: central venous catheter, removing, instructions, minimize complications, conscious and stable patient
- Lead-in keywords: what instructions
Question ID
Qdxi-EnNJhVpZ_U-PuD_5G
Practise the full NORCERT 8 Mains-2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Fluid and Electrolytes: Balance and Distribution Questions
- All are crystalloid solution; except:
- ECG of the patient is showing ST depression, Prominent U wave and inverted T wave. Which of the electrolyte imbalance present?
- A patient reports calcium loss. What is the nursing intervention?
- The principle of hemodialysis in which the water is moving under high pressure to an area of lower pressure is:
- Measurement of arterial blood gas shows pH: 7.2, PaCO2 : 70 mm Hg, HCO3: 27 mmol/L and PaO2: 59 mm Hg. Interpret this:
- Fluid volume deficit or hypovolemia describes the loss of
- A patient presents to the emergency department with a serum pH of 7.25, pCO2 of 40 mmHg, HCO3 of 22 mEq/L, sodium of 150 mEq/L, and chloride of 100 m…
- A 65-year-old patient is admitted to the hospital with a serum sodium level of 132 mmol/L. Despite being asymptomatic at admission, the patient begin…
- You are assessing a patient who is experiencing hyperventilation, resulting in a below-normal carbon dioxide (CO2) level. The patient is exhibiting s…
- A patient undergoes nasogastric suctioning for several days. Which electrolyte imbalance is most likely to occur due to this treatment?
More NORCERT 8 Mains-2025 Questions
- A patient admitted in the ICU is receiving feeding through a Ryles tube. The nursing officer is about to give the next feed, which is scheduled for e…
- What clinical condition is shown in the image below?
- What is the most significant diagnostic test that needs to be done prior to a lumbar puncture?
- Identify the device shown in the image.
- The nurse is monitoring a child with burns during treatment. Which assessment provides the most accurate guide to determine the adequacy of fluid res…
- Which of the following assessment techniques should be avoided in a child with Wilms' tumor?
- A nurse is caring for a schizophrenia patient who is experiencing auditory hallucinations. Which intervention is MOST appropriate?
- A belief that persists despite evidence to the contrary is characteristic of what?
- A schizophrenic patient with renal failure is admitted to the psychiatric ward for dialysis. When the time for the procedure arrives, the patient ref…
- Which value can be primarily affected if there is a delay in transferring an arterial blood sample for gas analysis and the sample is not refrigerate…