# A nurse is caring for a client receiving hemodialysis when the client suddenly develops chest pain, dyspnea, and hypotension. The dialysis machine alarms indicate air detection. What is the nurse's priority action? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541421 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client receiving hemodialysis when the client suddenly develops chest pain, dyspnea, and hypotension. The dialysis machine alarms indicate air detection. What is the nurse's priority action? A 58-year-old client with end-stage renal disease is receiving hemodialysis treatment. During the third hour of dialysis, the client suddenly complains of severe chest pain and difficulty breathing. The nurse observes that the client appears anxious and diaphoretic. Vital signs show: blood pressure 85/50 mmHg (baseline 140/90 mmHg), heart rate 120 bpm, and respiratory rate 28/min. The dialysis machine's air detection alarm is sounding. ## 보기 1. Administer oxygen via nasal cannula at 2 liters per minute 2. Increase the client's fluid replacement rate immediately 3. Continue dialysis while monitoring vital signs closely 4. Immediately clamp the venous line and place client in Trendelenburg position **✔ 정답** **정답: 4** ## 해설 Clamp venous line and place in Trendelenburg position immediately to stop air entry and trap air in right ventricle. Other actions like oxygen are secondary after this priority intervention. ## 심화 해설 Understanding the Priority: Air Embolism During Hemodialysis This clinical scenario describes a classic presentation of a venous air embolism during hemodialysis. The sudden onset of chest pain, dyspnea, and hypotension, combined with the dialysis machine's air detection alarm, is a life-threatening emergency. The priority is not to administer oxygen or fluids first, but to immediately stop the entry of air and position the client to minimize harm. The correct action is to immediately clamp the venous line and place the client in the Trendelenburg position. Pathophysiology and Clinical Manifestations An air embolism occurs when air enters the venous circulation. In the context of hemodialysis, a breach in the circuit integrity, a loose connection, or an empty air trap can allow air to be pumped into the bloodstream. The air travels to the right ventricle and pulmonary artery, creating an "air lock." This obstruction prevents blood from reaching the pulmonary circulation for oxygenation, leading to sudden hypoxemia, chest pain, and dyspnea [1,2]. The obstruction of right ventricular outflow also causes a rapid decrease in cardiac output, resulting in the profound hypotension (85/50 mmHg) and reflex tachycardia (120 bpm) observed in this client [3]. The anxious and diaphoretic presentation is a direct result of the acute cardiovascular collapse and air hunger. Rationale for Priority Interventions The immediate priority is to stop the source of the air and prevent further embolization. Clamping the venous line directly halts the flow of air from the machine into the client [1,3]. The second critical step is positioning. Placing the client in the Trendelenburg position (head down, feet up) and on their left side (left lateral decubitus) is a classic intervention for venous air embolism. This position serves two purposes: it helps trap air in the apex of the right ventricle, away from the pulmonary outflow tract, and it may prevent air from traveling retrograde into the cerebral venous system, a complication that can cause fatal cerebral air embolism infarction [2,4]. Case reports highlight that mishandling of central venous catheters, such as leaving a lumen open to air, can lead to catastrophic cerebral air emboli, even days after placement [2,3]. The same principle applies during active dialysis when air is detected. Why Other Options Are Not the Priority While the other options are important, they are secondary to stopping the air entry and repositioning the client. - **Administering oxygen (Option 1):** While the client is hypoxemic and requires high-flow oxygen (typically 100%), this intervention addresses the consequence of the air embolism, not the cause. The air lock must be managed first for oxygenation to be effective. - **Increasing fluid replacement (Option 2):** Fluid boluses can help support blood pressure, but they will not resolve the mechanical obstruction caused by the air lock in the right ventricle. The air must be evacuated or repositioned. - **Continuing dialysis with close monitoring (Option 3):** This is contraindicated. The air detection alarm indicates a system malfunction that is actively pumping air into the patient. The procedure must be stopped immediately to prevent a fatal outcome [1,3]. Key NCLEX-RN Safety Principle In any scenario involving a suspected air embolism, the nursing process dictates that the immediate focus is on preventing further harm by eliminating the source of air and using gravity (positioning) to mitigate the physiological impact. This aligns with the safety and infection control category, where preventing iatrogenic complications like air embolism is paramount, especially during high-risk procedures such as central venous catheter manipulation and hemodialysis [1,2,3]. References (research sources) - [3]Simple Mistakes Causing Catastrophic Complications: Central Venous Catheter Removal Leading to Cerebral Air Embolism.Research articleOzair S, Sharma I, Raza HAM, Khanal S, Walters R, Boldizar B. (2025) · DOI: 10.1155/crcc/8590063 ## 임상 시나리오 Managing Air Embolism During HemodialysisImmediate Response to a Life-Threatening Complication Upon detecting an air embolism, the priority action is to immediately clamp the venous return line and stop the dialysis pump. This prevents further air from entering the patient's circulation. Position the patient in the left lateral Trendelenburg position (head down, left side down). This maneuver traps air in the right atrium, preventing it from advancing into the pulmonary artery and causing an air lock. Administer 100% oxygen via a non-rebreather mask at a high flow rate (e.g., 15 L/min). This helps to reduce the size of the air embolus by creating a diffusion gradient that promotes nitrogen absorption from the bubble. CautionNever resume dialysis until the circuit has been thoroughly inspected and the source of the air leak is identified and corrected. Continuously monitor for signs of cardiac arrest, as a massive air embolism can lead to pulseless electrical activity. ## 핵심 개념 - **Venous Air Embolism** — A life-threatening condition where air enters the venous system, travels to the right ventricle, and creates an air lock that obstructs pulmonary blood flow, causing sudden cardiovascular collapse. - **Trendelenburg Position** — Positioning the patient supine with the head lower than the feet; in air embolism, this helps trap the air in the right atrium's apex, away from the pulmonary artery. ## 같은 주제 문제 - [A nurse is assessing a patient who has just completed a hemodialysis session. Which assess…](https://mymerci.kr/pages/nclex_q.php?qn_id=541416) - [A nurse is caring for a client receiving hemodialysis. Which assessment finding would be t…](https://mymerci.kr/pages/nclex_q.php?qn_id=541417) - [A nurse is caring for a client receiving hemodialysis. 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