The nurse changes the client's CVAD dressing and the client suddenly complains of chest pain and dizziness. Which should the nurse implement next?
1. Increase the infusion rate of the IV fluids.
2. Remove the central line and apply pressure.
3. Clamp the central line and notify the provider.
4. Place client in left lateral Trendelenburg position.
4
4 and 3. Client complaints of chest pain and dizziness during a central line dressing change are consistent with clinical indicators of air embolism; this occurs when a large air bolus enters the client's vessel and travels to the heart. The nurse implements interventions to prevent air embolism by assisting the client to Trendelenburg position during the dressing change, asking the client to bear down, if possible, when changing tubing, and clamping all tubing during tubing changes. To prevent the air emboli from migrating farther into the client's pulmonary vasculature, the nurse clamps the proximal tubing, quickly positions the client on the left side, and instructs the client to remain in this position. Then the nurse calls for emergency assistance.
1. The nurse avoids increasing the infusion rate because it potentially drives the bolus farther into the client's cardiopulmonary vasculature.
2. The nurse should clamp the CVAD.
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