March 2010, Volume 40 Number 3 , p 72 - 72
TWENTY MINUTES AGO, Celia Fletcher, 72, underwent insertion of a nontunneled central venous catheter via a right subclavian approach. Now she's restless and complains of shortness of breath and pleuritic chest pain. You take her vital signs: BP, 140/90; heart rate, 120; respirations, 28; and SpO2, 90% on room air. When you auscultate her lungs, you note decreased breath sounds on the right. She also has hyperresonance to percussion on the right.Ms. Fletcher was admitted earlier today for a fractured left hip. She has stage 1 hypertension, which is being treated with lifestyle modifications and a thiazide-type diuretic, but has no other significant medical history and isn't taking any other medications. On admission, her vital signs were BP, 130/80; heart rate, 94; respirations, 20; and SpO2, 96% on room air. Because of repeated unsuccessful attempts at obtaining peripheral venous access, the healthcare provider inserted a central venous access device (CVAD).Based on Ms.