Question

A patient with a triple-lumen subclavian catheter has been receiving total parenteral nutrition, maintenance fluids, and antibiotics by the catheter. He has been slightly confused. Suddenly he grasps the catheter and pulls it out. He then complains of shortness of breath, and his pulse oximetry indicates an SpO2 of 84%. How should this patient be positioned?

A. Head down, left side
B. Head down, right side
C. Head of bed elevated, left side
D. Head of bed elevated, right side

Answer 1

The patient, showing signs of a potential air embolism after pulling out the subclavian catheter, should be positioned in the left lateral decubitus (left side) and head-down position. Therefore, the answer is A. Head down, left side.

Step-by-step explanation:

In this scenario, the patient's sudden shortness of breath and low oxygen saturation (SpO2 of 84%) after pulling out the triple-lumen subclavian catheter suggest a potential air embolism. The correct position for managing an air embolism is to place the patient in a left lateral decubitus (left side) and head-down position.

Therefore, the appropriate answer is A. Head down, left side.

This position helps trap air in the right atrium, preventing it from traveling to the pulmonary artery and causing further complications. It is crucial to initiate immediate interventions, secure the catheter site, administer oxygen, and notify the healthcare team for further management, which may include emergent interventions to address the air embolism and stabilize the patient.