We are updating our policies and competencies on CVC care and maintenance. I was trying to find some current information on how long a patient should remain in bed post removal. I wasn't able to find anything specific in any of our references. I would appreciate some advice on what practices are in other facilities.
Thank you!
Becky W.
You are correct- there is only low level evidence to answer this question. But you also need to realize that all evidence for causes, prevention, and management for vascular air emboli associated with VADs is taken from principles of anatomy, physiology of blood flow, mostly derived from animal studies and clinical case reports of single or multiple patient events. Regarding the issue of how long in bed, are you thinking about being in the completely flat supine position or supine with the head elevated. If elevated, by how many degrees is safe? I have only been able to find 3 "suggestions" based on expert clinical opinion. Those are 10 minutes, 30 minutes, and 60 minutes for the patient to be completely flat and supine, with an air-occlusive dressing. There is a case study of an adult who went outside to smoke immediately after CVC removal. This case documented by radiology techniques that there was air entrained into the bloodstream by way of an intact fibrin sheath. Inhaling to smoke while standing adds additional risk factors. The risk is also increased by hydration status; hypovolemia adds to risk of air emboli, especially when standing. You should read the new standard on Air Emboli from the INS Standards of Practice, with comprehensive list of references on this issue is included. Lynda Cook is also speaking on this issue at INS this year. 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