The reason for a Valsalva maneuver or holding the breath if a Valsalva is contraindicated is to increase intrathoracic pressure and reduce the risk of venous air embolism. Patient positioning is also critical. When the exit site is at or below the leve of the heart, VAE is less likely. A femoral site in a supine patient is virtually always going to be at or below the level of the heart, reducing VAE risk. I have never seen any literature stating Valsalva or holding the breath was NOT necessary with a femoral line removal, but that does not mean that it can not happen. The CVAD tip is in the IVC vs SVC but still subject to the intrathoracic pressures. To be on the safe side, I would still do this step and put a petroleum based ointment on the dressing regardless of where the site was. While the femoral site is less likely, anything could happen. Lynn
The reason for a Valsalva maneuver or holding the breath if a Valsalva is contraindicated is to increase intrathoracic pressure and reduce the risk of venous air embolism. Patient positioning is also critical. When the exit site is at or below the leve of the heart, VAE is less likely. A femoral site in a supine patient is virtually always going to be at or below the level of the heart, reducing VAE risk. I have never seen any literature stating Valsalva or holding the breath was NOT necessary with a femoral line removal, but that does not mean that it can not happen. The CVAD tip is in the IVC vs SVC but still subject to the intrathoracic pressures. To be on the safe side, I would still do this step and put a petroleum based ointment on the dressing regardless of where the site was. While the femoral site is less likely, anything could happen. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861