Question

A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, he connects a 10-ml syringe to the catheter and withdraws a sample of blood. He then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. She should:

a. place the client in a supine position and prepare to perform cardiopulmonary resuscitation
b. place the client in high-Fowler's position and administer supplemental oxygen
c. turn the client on his left side and place the bed in Trendelenburg's position
d. Position the client in the shock position with his legs elevated

Answer 1

In the event of an air embolus post-subclavian central line insertion, the client should be turned on the left side and placed in the Trendelenburg position to prevent air from traveling to the heart and lungs, with continuous monitoring and preparation for potential CPR.

Step-by-step explanation:

When a patient experiences symptoms of an air embolus after insertion of a subclavian central line, the immediate action should be to turn the client on his left side and place the bed in Trendelenburg's position. This is option c. This position helps prevent the air from traveling to the lungs and heart and allows it to rise to the highest point in the body, which is now the left atrium. Meanwhile, the nurse should monitor vital signs, prepare for further emergency actions such as cardiopulmonary resuscitation (CPR) if needed, and notify the physician immediately. Additional measures include administering supplemental oxygen and ensuring that equipment and medications for resuscitation are ready for use if the patient’s condition deteriorates.

Answer 2

In the case of an air embolus after a central line procedure, the patient should be turned on the left side and placed in the Trendelenburg's position, administered oxygen, and immediate medical assistance should be sought.

Step-by-step explanation:

When a patient becomes confused, disoriented, and pale after the disconnection of a syringe from a subclavian central line, the nurse suspects an air embolus. To manage this, the nurse should turn the patient on their left side and place the bed in the Trendelenburg's position. This position helps to trap air in the apex of the right atrium, reducing the risk of it moving to the lungs or cerebral circulation. The nurse should then administer oxygen and notify the medical team immediately for further assessment and intervention.