Prevention of Air Embolisms When Removing Central Lines

Central lines provide direct access into the blood stream. Specific conditions may require placement of these lines, and they can remain in place for long-term use. Care must be taken with the removal of central lines to decrease the incidence of complications such as air embolism.

Function

• A central line is also referred to as a central venous catheter, or CVP line.

  A physician may order the placement of this line for various reasons including administering medications, chemotherapy, administering fluids and obtaining blood samples.

  The central line is a narrow and hollow silicone tube that is inserted through the skin into a vein in the neck. The tip of the line, or catheter, sits in a large vein. The placement of the line is in the vein above the right chamber of the heart.

  The external portion of the catheter may consist of two to three tubes or lumens, that join as one. They remain separate inside the larger tube.

  The central line must be checked daily to ensure proper functioning. Make sure the cap at the end of the catheter called, "the positive pressure device," is in should be taped, and the dressing should be clean and dry.

  Flushing the central line with an anti-coagulant may be preformed, especially if the line is not being used. This is done to prevent blood clotting.

Prevention

• Daily observation may indicate a need to remove the central line.

  Some of these may be bleeding, blood clot in the tubing and infection. Arrhythmias may result from the catheter irritating the heart. It's also possible to puncture a lung when inserting. An air embolism may result, thus prompting the removal as well.

  Air embolisms occur when the pressure gradient exists favoring entry of gas. This happens when a blood vessel is open.

  The pressure in the veins and arteries are greater than the atmospheric pressure. This may indicate why an air embolism doesn't occur when a blood vessel is injured.

  In the veins above the heart, located in the head and neck, the pressure is less than atmospheric pressure, thus trauma or injury may allow air to enter.

  It's imperative to tilt the head of the bed down when removing a central line, due to the pressure gradient of the blood vessels. Proper positioning is essential to preventing an air embolism when removing the central line.

  Central lines should be removed by a qualified health professional under direct supervision of a physician. Any problems observed should be reported to a physician immediately.