Question

A client who is receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What should be the nurse's priority action? a. Have the patient turn on the left side and perform a Valsalva maneuver. b. Clamp the intravenous (IV) tubing to prevent more air from entering the line. c. Have the patient take a deep breath and hold it. d. Notify the health care provider immediately.

Short answer

The nurse's priority action should be a. Have the patient turn on the left side and perform a Valsalva maneuver.

Step-by-step solution

- Understanding the complication

Recognize that an air embolus is a medical emergency in which air enters the bloodstream and can travel to the lungs or heart causing a life-threatening situation.

- Identifying the correct response

Recall that the priority in such cases is to prevent more air from entering the circulation and to position the patient so as to minimize the risk of the air traveling to a critical area like the heart or lungs.

- Recognizing the rationale behind actions

Understand that having the patient turn on the left side would position the air away from the heart and large vessels and performing the Valsalva maneuver would increase intrathoracic pressure, potentially preventing air from entering the heart or reducing the amount of air entering. Clamping the IV line may be part of the protocol, but it would not address any air that has already entered the bloodstream. Notifying the health care provider is important, but it is not the immediate action the nurse should take before dealing with the emergent situation.

Key concepts

Parenteral Nutrition Complications

Parenteral nutrition (PN) is a form of feeding where a person receives their nutritional needs through a vein, bypassing the usual process of eating and digestion. Although PN is life-sustaining for individuals who cannot ingest food orally or have severe digestive disorders, it comes with potential complications.

Parenteral nutrition complications can range from minor to very serious. Common issues include infections, particularly at the site where the central venous catheter (CVC) enters the body. This risk can be reduced through meticulous catheter care. Other complications that can occur are metabolic disturbances, such as glucose imbalances, and liver dysfunction over time.

A particularly acute complication is an air embolism, which occurs when air enters the bloodstream. If not managed promptly and effectively, an air embolism can lead to life-threatening conditions, including cardiac arrest, stroke, and respiratory failure. The emergency response to this situation, such as positioning and maneuvers to contain the air, is crucial and a part of the standard emergency nursing interventions for such complications.

Central Venous Catheter Care

The use of a central venous catheter (CVC) is integral to administering parenteral nutrition, but the catheter itself requires diligent care to avoid complications, including infections and blockages. Effective central venous catheter care involves several routine actions.

• Always follow strict aseptic techniques during the insertion and maintenance of the catheter.
• Regularly inspect the insertion site for signs of infection or inflammation.
• Change dressings as recommended following protocols to minimize infection risks.
• Ensure the securement of the catheter to prevent it from moving or getting dislodged, which could introduce air into the system, potentially leading to an air embolism.
• Regularly flush the CVC with saline or heparin, according to institutional policy, to keep the line clear of blockages.

Education on proper CVC care should be provided not just to healthcare staff but also to patients and their families when home care is required.

Emergency Nursing Interventions

Emergency nursing interventions are the immediate, lifesaving actions taken when a patient experiences a serious complication such as an air embolism. Quick recognition and response is paramount.

The interventions for managing an air embolism include positioning the patient on their left side, which helps prevent air from traveling to the heart, and performing the Valsalva maneuver — instructing the patient to attempt to exhale against a closed airway, which increases intrathoracic pressure.

Instructing the patient to turn on their left side and perform a Valsalva maneuver is a specific emergency intervention that can save a patient's life. Other essential interventions might include:

• Clamping the IV line to stop air from entering the bloodstream.
• Administering supplemental oxygen to aid in the absorption of small air bubbles.
• Preparing to assist with more advanced life support measures if the patient's condition deteriorates further.

Continuous monitoring and immediate notification of a healthcare provider are essential to ensure the patient gets the comprehensive care required following such emergency interventions.