To reduce the risk of air embolism, all central lines should be removed in Trendelenberg position or flat and either in a Valsalva Maneuver (blow into a 20mL Syringe) or on expiration (Intrathoracic pressure needs to be greater than atmospheric pressure).
Withdrawal of blood and removing central lines is identical to that of PICC lines.
Complications
- Air embolus
- Catheter fracture and embolism
- Dislodgement of thrombus/fibrin sheath
- Haemorrhage/bleeding
- Arterial complications
- bleeding
- compression
- brachial plexus
If a patient colapses suddenly Potential air embolus
Call arrest team 2222. CPR if pulseless.
Air Embolism
- Emergency situation
- Symptoms
- chest pain
- dyspnoea
- coughing
- agitation
- Signs
- acute Sp02 desaturation
- hypoxaemia
- tachycardia
- hypotension
- sucking air sounds
- murmur
- arrhythmia
- Management
- left Trendelenburg position
- high flow O2
Resistance
- Never pull a central line against resistance
- Stop if continuing resistance felt and get senior help
Non-intact PICCline
- Occurs if the catheter breaks and the remnant is completely retained
- Immobilise the limb and explain clearly to the patient the need to keep the limb immobilised
- Carefully apply TegaDerm over the insertion site
- Call senior help ASAP