The nurse is assisting a doctor with the removal of a central venous catheter. To prevent complications, the patient should be instructed to?

Appeared in: GMCH Chandigarh - 2019

Explanation

The Valsalva maneuver, which involves holding one's breath and bearing down, is the standard procedure to prevent air embolism during CVC removal.
This action significantly increases intrathoracic pressure, making it higher than atmospheric pressure.
This positive pressure gradient prevents air from being sucked into the large vein through the catheter exit tract, thus avoiding a potentially fatal air embolism.

Option A: Adson's maneuver is a diagnostic test used to assess for Thoracic Outlet Syndrome by checking for compression of the subclavian artery. It has no role in the removal of a CVC.
Option C: While turning the head away from the insertion site can improve the provider's visibility and access, it is not the primary action to prevent air embolism. Grasping the siderails is irrelevant to the prevention of this specific complication.
Option D: This position is incorrect and potentially dangerous. Hyperextending the neck could stretch the vein, potentially keeping the catheter tract open after removal and increasing the risk of air entry.

Clinical Relevance

Nursing practice connection: Use the key finding related to Complication prevention during central venous catheter (CVC) removal to guide bedside assessment, documentation, and the next nursing action.
Air embolism is a rare but life-threatening complication of CVC removal. The nurse's role in providing correct patient instructions and ensuring proper technique is a critical patient safety intervention.
The nurse must also be prepared to manage an air embolism by immediately placing the patient on their left side in the Trendelenburg position (left lateral decubitus) and administering 100% oxygen.
What if the patient is intubated, unconscious, or unable to follow commands? The nurse or provider should time the catheter removal to coincide with the end of inspiration or the expiratory phase of ventilation, when intrathoracic pressure is highest. The patient should also be placed in the Trendelenburg position.

How to Approach the Question

First, identify the procedure in the question: removal of a central venous catheter.
Next, recall the most critical, life-threatening complication associated with this procedure, which is an air embolism.
Analyze the options to determine which action directly prevents air from entering the venous system.
Recognize that the Valsalva maneuver is specifically designed to increase intrathoracic pressure.
Connect this physiological effect to the problem: increased internal pressure will oppose the entry of atmospheric air into the vein.
Eliminate the other options by identifying their purpose (Adson's is diagnostic) or lack of a relevant mechanism (head turning).

Concept Tested & Keywords

Concept Tested: Complication prevention during central venous catheter (CVC) removal
Stem keywords: central venous catheter, removal, complications, instructed
Lead-in keywords: instructed to
Negative lead-in flag: false

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E6 Nursing Fundamentals Taylor p. 804-806

Practise the full GMCH Chandigarh - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.