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Our policy states to put the HOB all the way down, unless the patient just can't tolerate it, then we put it down as far as possible. I usually keep it up around 5 degrees or so, just a touch, totally flat just seems to be a bit uncomfortable for our open hearts!
Follow your hospital protocol on this one. Tell your COPD patient to bear with you while they lay flat for awhile. Explain that flat is the safe way to remove a central line. Unless your patient desats to dangerous levels for a prolonged time, they will do okay even if they aren't comfortable.
Policy or best practice? I have never seen a serious complication from removing a TLC or other central line reguardless of HOB position. No doubt flat is best but I have removed hundreds many with HOB at 30deg evelation. We had one staff member that routinely removed them with the patient sitting up in chair-(not recomended). It also depends on insertion site. I.J. you can apply direct pressure to site, sub clav it's a bit trickier to apply pressure. Also is the patient cooperative- can they hold an inspiration breath long enough to pull the line? I would love to see some actual studies that indicate if "head flat" is necessary or just an "old wives tale" that has been passed down for ever. My experience says it's just a big to do about nothing. After all patients yank them out on thier own all the time with no special training at all- never saw it kill someone(although the nurse caring for the patient was tempted to).
Depends upon your hospital's policy, I guess. I don't see where a 20 degree elevation would cause a problem. People with COPD feel as though they cannot breathe anyway. Why cause even more anxiety? Just my opinion...
You've obviously never had to deal with a COPDer that gets a big, fat air embolism from the TLC removal at 20 degrees. The pt was having the TLC pulled before being discharged to home; went unresponsive, sent back to the ICU, where we had HAD her for the previous 2 weeks detoxing; died within 12 hrs. KEEP THE HOB DOWN and BEAR DOWN!! Thank goodness MY name wasn't on that chart! Lawsuit!
Once I was assisting a fellow day shift nurse pull a line so the tip could be cultured. I was leaving from night shift and just helped out b/c it was my pt earlier. I held the specimen cup and watched her do everything right until she pulled as Fast and as Hard as she could on the line! It was out in a flash. I couldnt even breath or speak. Thought I was gonna SH*T myself. I immedately ran to the patients side and watched her like a hawk while the other nurse finished collecting the tip. I was so scared but I didnt want to say anything in front of the pt. Since then I stay clear of this particular nurse. Her methods scare me.