A nurse is preparing to change parenteral nutrition (PN) solution bag and tubing. The client’s central venous line is located in right subclavian vein. The nurse asks client to take which essential action during tube change?

Correct Answer: B. Inhale deeply, hold it, and bear down.

The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tube changes. The nurse asks the client to take a deep breath, hold it, and bear down. Make sure all connections are clamped and closed. Clamp catheter, position patient in left Trendelenburg position, call health care provider, and administer oxygen as needed.

• Option A: Option A is incorrect because if the intravenous line is on the right, the client turns his or head to the left. This position increases intrathoracic pressure. Central line management is a crucial skill that is necessary on a routine basis to help lessen or prevent catheter-based infections and complications. Initial placement of central lines is typically by trained physicians, physician assistants, and nurse practitioners in a sterile fashion.
• Option C: An air embolism may occur if IV tubing disconnects and is open to air, or if part of the catheter system is open or removed without being clamped. Symptoms include sudden respiratory distress, decreased oxygen saturation levels, shortness of breath, coughing, chest pain, and decreased blood pressure.
• Option D: Exhaling can cause the potential for an air embolism during the tube change. Routine evaluation by every team member will ensure that appropriate handling and care of the central line is being performed to help reduce the risk of catheter-associated complications.