Which actions would the nurse take when removing a radial artery catheter? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply

Question

1. Don a sterile gown, sterile gloves, and eye protection.
2. Send the tip of the catheter to the laboratory for culture and sensitivity.
3. Remove the dressing.
4. Apply direct pressure to the insertion site after the catheter is removed.
5. Plan frequent observation of the site after removal of the catheter.

Answer 1

3,4,5
Rationale 1: The nurse should wear clean gloves and eye protection. A gown may be worn, but it does not have to be sterile.
Rationale 2: Routine cultures of catheter tips are no longer recommended.
Rationale 3: The nurse must remove the dressing to have adequate visualization of the insertion site.
Rationale 4: Direct pressure is required to support hemostasis.
Rationale 5: The nurse must continue to assess the site for hematoma formation or for frank bleeding after the catheter has been removed.