Central Line Case study Essay

869 Words Mar 8th, 2014 4 Pages
The patient is a 45 year old man who had GI surgery 4 days ago. He is NPO, has a nasogastric tube, and IV fluids of D51/2saline at 100 mL/hr. The nursing physical assessment includes the following: alert and oriented; fine crackles; capillary refill within normal limits; moving all extremities, complaining of abdominal pain, muscle aches, and "cottony" mouth; dry mucous membranes, bowel sounds hypoactive, last BM four days ago; skin turgor is poor; 200 mL of dark green substance has drained from NG tube in last 3 hours. Voiding dark amber urine without difficulty. Intake for last 24 hours is 2500mL. Output is 2000mL including urine and NG drainage. Febrile and diaphoretic; BP 130/80; pulse 88; urine specific gravity 1.035; serum …show more content…
Pt.’s with NG tubes loose potassium through suctioning. Sodium of 140 is normal but on the higher end which is indicative of dehydration. Chloride of 92 is a little low which is interesting because the sodium is normal-high and usually chloride follows sodium. Mag of 1.4 is low maybe because of low calcium.
4.) The physician is planning to place a percutaneous central line to infuse TPN. Which site is recommend and why?
A percutaneous central line is entered into the patient’s subclavian vein. Because TPN solution is concentrated it is better to have CVC access in the subclavian vein so the solution has less distance to travel to its destination. This reduces the risk of the line clotting or damaging the vein.
4b.) What are the nurse's responsibilities for placement of the central line?
The nurse is responsible for positioning the patient and should assess the patient throughout to see how well he is tolerating it. If the patient is on a heart monitor, the nurse should monitor vital signs and heart rate as the catheter is being put in for any fluctuations. Afterword’s, the nurse should assess for complications or adverse reactions like pneumothorax. Make the patient comfortable and listen to bilateral breath sounds. Obtain a stat XRAY to verify correct placement.

The assessment includes: Date and time of procedure, name of provider, site of insertion, type of fluid infusing in each lumen, blood

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