I work on a Cardiovascular Intervention Unit. I've been on this unit almost 2 year which is the duration of my career. The other night I followed thru with an order to d/c a Rt. IJ (cordis sp?) central line on a patient that was s/p day #4 fem-pop. First, I checked that labs were all WDL. I prepared everything according to sterile technique. The patient was in a sitting position in a chair (which seems to be the only questionable thing I can find with the removal). Per sterile tech. I clipped the two sutures holding the central line in place. I had the patient take a breath in, exhale & inhale again then hold it while I drew out the line. The line was intact. The pateitn commented that the removal wasn't so bad at all. She then coughed really hard. With in seconds her breathing pattern changed, she became flushed in the face and she stop responding to me. I called for help & had a Rapid Response called. Initially, MD thought she had an air emboli & the ICU Hospitalist flipped that the patient wasn't in Trendelenburg when I pulled, but that isn't required as part of our Policy & Procedure. The patient being in a chair seems to be of issue, but I have seen central line (IJs too) pulled while the patient is in a seated position before as well as pulling them in a seated position myself. They did an u/s of the jugular at the bedside & there was a large clot. The on-call MD's all seemed so worried to take an further steps as instructed by the vascular surgeon and the cardiogist. I'm really worried because I've already been told that this is going to be a risk mang. issue. All because she was in the chair???
Mar 20, '10
The patient should be laying in as flat a position (preferably slight trendelenburg) as they can tolerate and they should be holding breath in order to prevent air embolis.
Just to add that I was present for a code last week were an inexperienced nurse pulled a cordis out while the patient was sitting up in the bed and the patient decompensated in seconds and needed to be reintubated for suspected air emoblis.
Last edit by questionsforall on Mar 20, '10
: Reason: adding to post