The nurse is assisting the physician with the removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:
A. Perform the Valsalva maneuver as the catheter is advanced
B. Turn his head to the left side and hyperextend the neck
C. Take slow, deep breaths as the catheter is removed
D. Turn his head to the right while maintaining a sniffing position
Correct Answer: A. Perform the Valsalva maneuver as the catheter is advanced
The client who is having a central venous catheter removed should be told to hold his breath and bear down. This prevents air from entering the line.
Option B: Although there are many steps in the process of CVC removal, essential elements of the procedure include (for internal jugular and subclavian CVCs), positioning of the patient in the head down (Trendelenburg) position, having the patient perform a Valsalva maneuver as the catheter is being withdrawn, application of pressure to the catheter-entry site as the catheter is being withdrawn, placement of an air-occlusive dressing over the site after removal, and a period of post-procedure monitoring.
Option C: The patient is asked to take a deep breath, hold it, and bear down during the removal to avoid introduction of an air embolism. Breath-holding or Valsalva maneuver will increase intracardiac pressures. Immediate occlusion is required to prevent air embolism.
Option D: The patient’s head should be placed in a supine position with the head of the bed flat to reduce the risk of air embolism. Risk for air embolism increases when the catheter insertion site is above heart level (e.g., in a sitting position), if the patient is hypovolemic or during spontaneous inspiration.