A registered nurse (RN) is supervising a licensed practical … | 마이메르시 MyMerci
Leadership Management
문제
A registered nurse (RN) is supervising a licensed practical nurse (LPN) who is caring for a patient with a central venous catheter for chemotherapy administration. Which observation by the RN requires immediate intervention?
The RN is conducting routine supervision of an LPN providing care to a patient with a central venous catheter for chemotherapy administration.
1The LPN wears sterile gloves when accessing the central line port
2The LPN cleanses the injection port with alcohol for 15 seconds before access
3The LPN flushes the catheter with normal saline before and after medication administration
4The LPN disconnects the IV tubing to take a shower without clamping the catheter✓ 정답
해설
Disconnecting IV tubing without clamping the catheter requires immediate intervention because it risks air embolism, bleeding, and infection due to an open central line. Other options demonstrate proper CVC care practices within LPN scope.
심화 해설
Core Nursing ExplanationKey Concept Analysis: This question tests the critical safety principle of maintaining a closed system for a Central Venous Catheter (CVC). A CVC is a large-bore catheter whose tip terminates in a central vein (e.g., superior vena cava). Because it is directly connected to the central circulation, any break in the system poses severe, immediate risks, including air embolism, catheter-related bloodstream infection (CRBSI), and significant bleeding.
Answer Rationale: Key Point! Option ④ describes an action that creates an open pathway from the atmosphere directly into the patient's central venous system. Disconnecting the IV tubing without first clamping the catheter allows air to be sucked into the vein (especially during inspiration when intrathoracic pressure is negative), leading to a potentially fatal air embolism. It also exposes the catheter lumen to pathogens, drastically increasing infection risk. This is a critical safety violation requiring the RN's immediate intervention to stop the action and re-establish a sterile, closed system.
Distractor Analysis:
• Option ①: Watch out for confusion! While sterile gloves are required for inserting a CVC or during a dressing change, clean gloves are typically sufficient for accessing an injection port for routine medication administration or flushing. Using sterile gloves here is an excess of precaution, not a safety risk, and does not require immediate intervention.
• Option ②: Cleansing the port with an antiseptic (like alcohol) for 15 seconds is a standard practice to reduce microbial load. While some guidelines recommend a vigorous scrub for 15-30 seconds, 15 seconds is within an acceptable range and is not an immediate danger.
• Option ③: Flushing with normal saline before and after medication administration is a core standard to maintain catheter patency and prevent drug incompatibilities. This is correct practice.
Related Concepts: This scenario highlights the RN's supervisory role in ensuring patient safety and adherence to evidence-based infection control protocols. The principle of maintaining a closed system applies to all central lines, including PICC lines and implanted ports. Understanding the scope of practice for LPNs/LVNs is also tested here; while LPNs can often administer medications and perform CVC care under supervision, they must be competent in the critical safety steps.
Concept Summary
• Central Line Safety: Always maintain a closed system. Never leave a central line open to air.
• Immediate Risks of Open Catheter: Air embolism, hemorrhage, infection.
• Standard CVC Care: Scrub the hub, use aseptic non-touch technique (ANTT), flush with prescribed solution.
• RN's Supervisory Role: To observe, guide, and immediately correct unsafe practices by team members.
Side-by-Side Comparison!
Leaving open (Option ④): Risk of air embolism and infection.
Port Cleansing
Scrub with alcohol/chlorhexidine for 15-30 seconds.
Wiping briefly (
임상 시나리오
Nursing Clinical Practice GuideClinical Scenario: You are the charge RN on an oncology unit. During rounds, you see an LPN preparing to assist Mr. Johnson, a patient with a tunneled central venous catheter (Hickman catheter) for chemotherapy, with his morning shower. The LPN has gathered supplies but is about to disconnect the IV tubing from the catheter hub without applying a clamp.
Nursing Intervention Strategy:
1. Immediate Action (Assessment & Intervention): Politely but firmly say, "Please stop for a moment." Immediately apply a clamp to the catheter lumen. Explain the risk of air embolism. Ensure the catheter is securely clamped before any disconnection.
2. Re-establish Aseptic Technique: After the shower, don clean gloves. Scrub the catheter hub with a new alcohol swab for 15 seconds. Connect new, primed IV tubing or a sterile cap using a sterile non-touch technique.
3. Education & Supervision: Use this as a teaching moment. Review the facility's CVC care protocol with the LPN, emphasizing the "clamp before disconnect" rule. Document the event and the education provided.
4. Patient Monitoring: After the incident, assess Mr. Johnson for any signs of air embolism (respiratory distress, chest pain, anxiety, hypotension) or infection (fever, redness at site).
Patient Safety and Precautions:
• Never leave a central line open to air. Always have a clamp, closed syringe, or sterile cap ready before disconnecting.
• Use positive pressure flushing technique (push flush, clamp while still injecting) to prevent blood reflux and clotting.
• For showering, the catheter site should be covered with a waterproof dressing. The IV tubing can be disconnected only if absolutely necessary, and the catheter must be clamped and capped with a sterile device immediately.
Nursing Procedure & Medication FlowProcedure: Accessing a Central Line for Medication Administration
1. Perform hand hygiene. Don clean gloves.
2. Scrub the injection port (needleless connector) vigorously with an alcohol or chlorhexidine swab for 15-30 seconds. Let it dry completely.
3. Connect a syringe with normal saline. Aspirate for blood return to confirm patency.
4. Flush with normal saline using a push-pause technique.
5. Administer medication.
6. Flush again with normal saline (and heparin if per protocol).
7. Critical Step: Maintain positive pressure by continuing to inject the final flush while clamping the catheter or disconnecting the syringe to prevent blood backflow.
A Word from Your Senior Nurse
"Supervising other team members is a huge part of an RN's responsibility. It's not about being the 'police'—it's about being the final safety net for your patient. In this scenario, stopping that action before the disconnect could literally save a life. Always keep the 'worst-case scenario' in mind with central lines: air in the heart, massive infection, severe bleeding. Your knowledge and vigilance are what prevent those nightmares. On the NCLEX and in practice, your ability to spot the one action that breaks a fundamental safety rule is a superpower. Cultivate it!"
핵심 개념
Central Venous Catheter — A catheter placed into a large central vein (e.g., subclavian, jugular, femoral) with the tip terminating in the superior vena cava or right atrium. Used for long-term IV therapy, chemotherapy, TPN, and hemodynamic monitoring.
Air Embolism — A life-threatening condition where air enters the vascular system, travels to the heart or lungs, and obstructs blood flow. With central lines, it can occur if the catheter is left open to air, especially during inspiration.
Catheter-Related Bloodstream Infection — A bloodstream infection originating from a central venous catheter. A major complication prevented by strict aseptic technique during insertion and access.
Aseptic Non-Touch Technique — A standardized technique used during clinical procedures to prevent infection by not touching key parts of sterile equipment (e.g., syringe tip, catheter hub).
Positive Pressure Flushing — A flushing technique where the syringe plunger is continuously depressed while disconnecting from the catheter hub. This creates positive pressure within the lumen to prevent blood reflux and catheter occlusion.
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