Arterial blood is bright red and blood flow is substantial;. The nurse should observe the heart rate and rhythm, and inform the medical practitioner of any changes Drewett, Air embolism, where air enters the venous system, can also occur on insertion or up to 48 hours after removal.
The medical team and nurses should ensure that all lines are primed with fluid before connection and that there is no leakage in the system.
All ports should have luer lock connections and be clamped off if not in use. If a patient shows symptoms of an air embolus for example acute dyspnoea, low blood pressure , the medical practitioner should be informed immediately. Air emboli of less than ml rarely cause problems Hudak et al, , but a large pulmonary air embolus can cause death. A central venous catheter can act as a conduit for infection, which may result in septicaemia, if it is not cared for appropriately. The site should be observed daily for any redness or discharge.
Occlusion can also occur for a number of reasons, including kinking in the line, thrombosis and the precipitation of drugs in the line. If a patient has a catheter with more than one lumina inserted there is a possibility, especially if the patient is critically ill, that ramps extension sets may be attached to the line to administer a number of drug infusions.
If these lines are not adequately secured to the patient there is the potential for them to become tangled or kinked, causing occlusion. The catheter is a foreign body and the physiological response to a foreign body is a build-up of fibrin. Over time this can cause a thrombosis in the vein or within the lumen of the catheter.
If it is left untreated there is the likelihood of emboli dispersing to the lungs and other vital organs. Critically ill patients are often administered a concoction of highly potent drugs which have the potential to form solid deposits. This is sometimes caused by a chemical reaction and sometimes by an alteration in the solution so that the substance becomes less soluble Koenigsberg, The advice of a pharmacist should be sought to ascertain that the drugs administered are compatible with one another and lines should be flushed with normal saline 0.
The patient should be closely monitored and the catheter site and the system observed. Any handling of the line should be kept to a minimum to reduce the risk of contamination and the line should be securely fastened to the patient.
The dressing on the central venous site should be changed in accordance with hospital policy and procedures. It should always be changed using aseptic techniques and a transparent dressing is often used to allow observation for evidence of redness or discharge. The nurse usually removes the catheter after the medical practitioner has given an instruction to do so.
Alternatively, you can purchase access to this article for the next seven days. Buy now. Want to read more? Already subscribed? Try Nursing Standard Student Alternatively, you can purchase access to this article for the next seven days. Test for dampness of waveform. Provides baseline data about right atrial CVP pressures. Sterile procedure; occlusive dressing prevents blood stream infections. Waveform: Right Atrium The right atrium waveform is identical to the central venous waveform; it can be recognized by the triplet of peaks.
The highest peak is the a-wave ; and it represents right atrial contraction at the end of diastole. The following c-wave , which is generally smaller, represents closing of the tricuspid valve; this is the signification of beginning of systole.
The c-wave is followed by an x-slope or trough , which is caused by right atrial relaxation. The v-wave stands alone between two slopes, and it represents right atrial filling pressure during diastole. The following y-slope represents opening of the triscuspid valve. Check level of transducer with phlebostatic axis.
During first assessment of shift, zero transducer to air. Assess waveform for dampness. Maintain tight luer-lok connections and nonvented caps on stopcocks of pressure tubing. Record CVP pressure from the monitor Rationales Lateral positioning may result in variable pressure readings. Supine promotes consistency of conditions. Head-of-bed elevation has not been shown to alter pressure recordings significantly. Insures accuracy of readings. Insures representation of patient's BP on monitor.
Dampness may distort systolic and diastolic readings. Prevents risk of air embolism. CVP reflects a mean pressure in the right atrium. Turn stopcock of water manometer off to patient and fill water manometer up to 20 cm H 2 O. Align 0 zero of water manometer with phlebostatic axis. Turn stopcock of water manometer off to IV solution bag. Encourage the patient to take some normal breaths while the water descends the water manometer to the resting pressure. Read the water meniscus bottom of water level during end expiration of the patient's respiratory cycle.
As soon as a pressure is read, turn the stopcock of the water manometer off to the water column and flush the IV tubing of any blood backed up in the tubing. Leave the stopcock in the off position to the manometer when not in use. Lateral positioning may result in variable pressure readings. Be careful not to overfill water manometer! Equalizes pressure between water manometer with right atrium. Opens water manometer to patient's central venous circulation.
Patient's breathing allows water manometer to equalize pressure. On a water column, the water line is not flat but curved downward creating a meniscus. The bottom of the meniscus represents the true water level. The end expiration of the patient's respiratory cycle is the point at which intrathoracic pressures are not affected by breathing.
If the stopcock is not turned off to the water manometer when the manometer is moved above the patient, air embolism can occur. Any blood in the central catheter can generate clot formation and eventually occlude the catheter or worse cause a pulmonary embolism. Bundle of Practices Related to Nursing Care: All-Inclusive Catheter Cart or Kits: Having a cart or kit that has all necessary equipment for procedures reduces the risk of contamination of equipment when additional items are added to a sterile field.
The patient might go into hypovolemic shock! Encourage patient to drink more fluids. Increase IV fluid infusion rate. Transfuse blood if indicated. If CVP is high… The patient is in an overhydration or fluid overload state. Possibly the patient is in renal failure. Perhaps IV fluids are infusing too fast a rate. Fluid restriction. Diuretic to enhance fluid elimination. Reduce IV infusion rates.
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