Lines and Tubes Flashcards
(154 cards)
1
Q
Why should patients be mobilized early in the ICU?
A
- Reduces hospital stay/costs
- Improves patient’s QoL
2
Q
What 3 things should be considered when observing a patient’s lines and tubes?
A
- Where do they originate and terminate?
- What are they for?
- How do they affect my treatment?
3
Q
How does a pulse oximeter work?
A
- Emits 2 wavelengths of light
- Photo detector measures difference between light absorbed during systole and diastole
- Estimates arterial % SaO2
4
Q
How can a pulse oximeter be assessed for accuracy?
A
- Compare pulseOx HR to manual HR
5
Q
What are 5 factors that can affect accuracy of pulse oximeters?
A
- Cold fingers
- Nail polish
- Darker skin
- Motion
- Cardiac arrhythmias
6
Q
By what 2 methods can supplemental oxygen be delivered to a patient?
A
- Nasal cannula
- Mask
7
Q
What is the concentration of supplemental O2 delivered by a nasal cannula?
A
22 - 44 %
8
Q
How many liters of oxygen require a high flow oxygen system?
A
More than 6L/min
9
Q
Why may a nasal cannula be preferred to a mask?
A
- More comfortable
10
Q
What O2 concentrations can the air of a mask unit be increased to?
A
35 - 55 %.
11
Q
How is the amount of oxygen in air measured?
A
FiO2
Fraction of inspired oxygen
12
Q
What is the benefit of a partial non-rebreather mask?
A
- Higher FiO2 with less flow
13
Q
What are the typical FiO2 for 6L/min, 7L/min, and 8 - 10 L/min for a partial non-rebreather mask?
A
6L/min: 60 %
7L/min: 70 %
8-10 L/min: 80+ %
14
Q
What is the purpose of a nasopharyngeal tube?
A
- Suctioning of patients with poor cough and retained secretions
- Connects nose and the upper airway directly
15
Q
What are the two methods used to provide a sealed system for mechanical ventilation?
A
- Endotracheal tube
- Tracheostomy
16
Q
What is an endotracheal tube?
A
- Inserted into trachea through mouth
17
Q
What is a tracheostomy?
A
- Surgical procedure
- Incision made in tracheal rings
- Tube inserted
18
Q
Where are endotracheal tubes typically used?
A
- ICU
- Pulmonary specialty areas
19
Q
What risk is related to endotracheal tubes?
A
Damage to vocal cords.
20
Q
What should be done if an endotracheal tube is pulled from a patient?
A
- Check breathing
- Apply O2 or artificially breath for patient until re-intubated.
21
Q
What are 2 advantages of tracheostomy over endotracheal tubes?
A
- Decreased risk of vocal cord or tracheal injury./
22
Q
What should be done if an endotracheal tube is accidentally removed?
A
- Apply O2 or artificially breath for the Pt until the tube can be re-inserted
23
Q
What are the 2 advantages of a tracheostomy button?
A
- Maintains open stoma
- Allows direct suctioning
24
Q
What are 3 advantages of a Passy Muir Speaking Valve?
A
- Promotes use of upper airways
- Assists verbal communication
- Assists coughing
25
What are 2 requirements for the use of Passy Muir Speaking Valves?
- SaO2 must be > 90 for all day use
| - Must have a high humidity tracheal collar.
26
What are the 2 advantages of using a trachestomy collar?
- Humidifies/ moisturizes air
| - High flow O2
27
What ranges FiO2 can be used on a trachestomy collar?
21 - 100 %
28
What type of system should be utilized when ambulating with a trachestomy collar?
- Venturi system
29
What are 4 general advantages of artificial airways?
- Prevent airway obstruction
- Protect airway from aspiration
- Facilitate suctioning of sputum
- Closed system for mechanical ventilation
30
What are 5 general disadvantages of artificial airways?
- Cough less effective
- Reduced ciliary motion
- Interferes with communicaiton and nutrition
- Bypasses respiratory defense mechanism
- Tracheal stenosis
31
Is ventilation a contraindication to PT/ mobility?
No.
32
What 2 factors determine if a patient can receive therapy when on a mechanical ventilator?
- Medical stability
| - Mental status
33
Since the movement of artificial airways can irritate the patient's tissues, what considerations should you make during ambulation?
Stabilize tube.
| - May need assistance
34
What should be done if the patient's tube becomes dislodged during ambulation?
- Use manual ventilation to ventilate the patient
35
What are 5 uses of Ambu bags?
- Manually ventilate patients when ambulating
- Ventilate during suctioning
- Stimulate a cough
- Supplemental O2
- Increase volume of air during a breath
36
What is the focus of PT usually in patients with artificial airways?
- Mobilization
| - Clearance techniques
37
How should the PT monitor a patient with an artificial airway during treatment? (3 things)
- Make sure airway is stable before treatment
- Check breath sounds before, during, and after treatment
- Make sure tube does not change position
38
Are air leaks around a trach tube normal during mobility exercise?
Yes
39
What are 4 indications for the use of chest tube?
- Pneumothorax
- Hemothorax
- Pleural effusion
- Empyema
40
How is a chest tube held secure?
Sutured into place.
41
What 3 cavities are chest tubes typically inserted into?
- Pleural space
- Mediastinum
- Pericardium
42
Following what surgery are mediastinal and pericardial tubes typically utilized?
Open heart surgery
43
`Where are chest tubes typically inserted?
- Between 4th and 5th rib at mid or anterior axillary line posteriolateral to border of pec major
44
How should a chest tube patient be monitored by the PT? (3 ways)
- Check vitals
- Watch for bubbling in chambers (especially with movement)
- Make sure tube isn't kinked or blocked
45
Pts with chest tubes can participate in most treatment; what is the one consideration?
- Make sure draining system is kept below the level of the insertion site and suction can continue
46
What 4 interventions should a PT focus on during treatment of a patient with a chest tube?
- Position changes
- Shoulder ROM
- Ambulation
- Deep breathing exercises
47
What 5 measures are typically displayed on an EKG?
- HR
- RR
- SaO2
- BP
- EKG
48
If telemetry can't be used while ambulating a patient, what can be used instead?
A pulse oximeter.
49
What should be checked if a PT noticed an abnormal EKG?
Make sure all the leads are in place.
50
What are 3 types of pacemakers?
- Epicardial
- Endocardial
- Temporary
51
Where is an epicardial pacemaker located?
- Sewn or screwed into the heart muscle during open heart surgery
52
Where is an endocardial pacemaker located?
- In infraclavicular pocket
| - Leads from pacemaker attach to right atrium and ventricle
53
In what settings are temporary pacemakers typically used? Where do they attach?
- Used in acute care following surgery
| - Sewn outside of heart, and wires exit below xiphoid process
54
What is an ICD?
Automated Implantable Cardioverter-Defibrillator
55
What is an ICD used for?
Shocks the heart into a normal rhythm if it begins to undergo lethal arrhythmias.
56
What should a PT consider with a patient with an ICD?
- Make sure heart rate stays at least 10 beats below the point at which it activates.
57
Where are subclavian pacemakers and ICDs typically located?
Side of non-dominant upper extremity
58
What are ROM restrictions due to SCPM and ICDs?
- Shoulder FLX/ ABD limited to 90 degrees
| - No extreme shoulder EXT
59
What may be limited by the weight-bearing restrictions of a pacemaker/ ICD?
- Use of an assistive device
60
Where should pressure not be applied during treatment in a patient with a subclavian PM or ICD?
Axilla.
61
Since temporary pace makers do not increase HR with exercise, what scale should be used to measure exertion?
RPE.
62
What is an intra-aortic ballon pump? When does it inflate/ deflate?
- Catheter with ballon attached placed in aorta via the femoral artery
- Deflates during systole to allow passage of blood
- Inflates during diastole to prevent backflow.
63
Where are intra-aortic ballon pumps typically used?
- ICU
64
What artery is particularly assisted by intra-aortic ballon pumps?
Inflation of ballon during diastole prevents backflow so that blood may flow into coronary artery.
65
What load in the left ventricle is decreased by the intra-aortic ballon pump?
- Afterload
| - (amount of force needed to eject blood from the ventricle)
66
What joints of the patient may be mobilized when an IABP is being utilized?
- All UE joints as tolerated
- All contralateral LE joints as tolerated
- Ankle and foot of LE with catheter
67
Besides mobilization of joints, what is the other focus of PT intervention in a patient with an IABP?
- Prevent pulmonary impairments
68
If the IABP becomes dislodged WHAT DO YOU DO?
- Apply pressure
| - Call for the nurse
69
What is another name for a Swan Ganz Catheter?
Pulmonary Artery Catheter (PAC)
70
What is the use of the PAC?
- Monitors cardiac function in patients who are staying in the ICU long-term
71
What does a PAC measure specifically? (5 measure)
- Hemodynamics
- Right arterial pressure
- Pulmonary artery pressure
- Pulmonary artery wedge pressure
- Cardiac output
72
How is a PAC inserted?
- Through large peripheral vein, and guided through right side of heart to pulmonary artery
73
What are typical PAC pressures in the: RA, RV, PA (Systolic). PA (diastolic), and Pulmonary capillary wedge pressure?
```
RA: 0 - 8 mmHg
RV: 8 - 12 mmHg
PA (Sys): 15 - 30 mmHg
PA (Diast): 5 - 15 mmHg
PCW: 4 - 15 mmHg
```
74
What precautions should a PT take in a patient with a PAC before treatment?
- Ask someone if the patient is good to go
75
When should a PAC patient never be mobilized?
If pulmonary capillary wedge pressure is being measured
76
What level should the PAC transducer be kept at for accurate readings?
- 4th intercostal space
77
What are 4 complications related to PACs?
- Infections
- Line related sepsis
- Thrombus
- Pulmonary infarct/ pulmonary artery rupture
78
What are pigtail catheters typically used for? Why are they called pigtail catheters?
- Placed in heart or lung to drain fluid
| - Curved end (pigtail) prevents puncture
79
What helps control the rate of drainage of a pigtail catheter?
- A stopcock.
80
What PT implications are there for a patient with a pigtail catheter?
- Ask a professional to see if the patient can get up and be moved around
- Consider that the underlying pathology may limit the aggressiveness of your PT treatment.
81
What are aterial lines/ catheters typically used for?
The monitoring of BP, arterial blood gases, and pH>
82
What 2 other devices is the catheter typically attached to?
- Transducer
| - Pressurized flush device
83
What are 4 common sites of aterial lines/ catheters?
- Radial artery
- Femoral artery
- Brachial artery
- Dorsalis pedis artery
84
Why may a patient with an arterial line be immobilized?
To avoid kinking the line.
85
What precaution should a PT take when treating a patient with an arterial line?
- weight bearing and joint ROM are limited near the site of insertion
86
If a patient is stable with an arterial line, what activities may they participate in?
- All interventions
87
What will cause a patient with an arterial line to be strictly on bed rest? (2 possibilities)
- Catheter in sheath
| - Femoral artery line (hip flexion also limited to 30 degrees)
88
What type of arterial line will making standing or gait uncomfortable?
- Dorsal pedis line
89
What are 3 complications related to arterial lines?
- Bleeding
- Infection
- Lack of blood flow to tissues supplied by artery
90
If the transducer is placed above or below the 4th intercostal space, what complications may arise?
Above: BP falsely high
Below: BP falsely low
91
If an arterial line is pulled out, what is procedure?
- Apply pressure
| - Call for help
92
What are the 3 main types of venous catheters?
- Peripheral intravenous
- Central intravenous
- Peripherally inserted Central Catheter
93
Where are IVs typically inserted?
Into a peripheral vein in the hand or forearm
94
What are 4 uses of IV lines?
- Drugs administration
- Fluids administration
- Blood transfusion
- Obtaining venous blood
95
What is a common complication of IV?
Infiltration if IV is inserted into tissue instead of a vein.
96
How long does an IV last?
3 - 5 day.s
97
If an IV line alarm sounds, what should be done?
- Check with nursing
98
What are 5 indications for central catheter use?
- Diagnostic information obtained by measuring central venous pressure and easy obtainment of blood samples
- Administration of medications that are caustic to peripheral veins
- Access when no peripheral veins are available
- Long term medications or parenteral nutrition
- Hemodialysis or plasmapheresis
99
What 4 veins are central venous catheters typically inserted into?
- Subclavian
- Internal/ external jugular
- Femoral vein
100
Are veinous catheters rigid or flexible?
Flexible
101
How are venous catheters held in place?
- Sutures
| - Staples
102
What is a long, slender, small, flexible tube that is inserted into a peripheral vein and advanced until it reaches a large vein in the chest?
PICC line (peripherally inserted central catheter)
103
What are 3 advantages of a PICC line over a standard central catheter line?
- Less infection rates
- Decreased risk of complications
- Can remain in place for long periods of time
104
Where are PICCs inserted, and where do they typically terminate?
- Begin in a vein in the upper arm
| - Terminate near the vena cava
105
What is a clinical implication of a patient with a PICC line?
- Nothing tight on the affected ARM
| - No blood pressure
106
What is a PCA pump?
- Patient controlled analgesia
107
What are 3 clinical implications for a patient with a PCA?
- Only let the patient deliver the medication
- Inform the nurse if the patient is unresponsive
- Monitor blood pressure
108
What are 5 categories of non-vascular lines and tubes?
- GI
- Renal
- Urinary
- Neurological
- Intergumentary
109
What patients use total parenteral nutrition?
Patients who can't use GI tract.
110
How is nutrition injected in a TPN line?
Through the central venous line.
111
What are 4 feeding tubes?
- Total Parenteral Nutrition (TPN)
- Nasogastric tube (NG)
- Dobhoff (Feeding) Tube
- Percutaneous Endoscopic Gastrostomy/ Jejunostomy (PEG/PEJ) tube
112
What is the purpose of a nasogastric tube?
- Empties stomach of gas and digestive fluids
| - Also for feeding
113
Where does a NG tube insert and terminate?
Inserts: Nostril
Terminates: Stomach
114
What patients recieve a Dobhoff tube?
- Short term feeding
- Patients who can't chew or swallow
- Functioning GI tract
115
Where does a Dobhoff tube insert and terminate?
Inserts: Nostril
Terminates: Beginning of small intestines
116
What is a percutaneous endoscopic gastrostomy/ jejunostomy?
- Placement of tube in stomach or jejunum for longer term nutriiton
117
What should be checked in a patient with an NG tube before ambulation?
- Suction
118
How should a patient NOT be positioned after eating with an NG tube?
- Supine
119
What should be done if a patient begins to vomit with their NG tube detached?
- Reattach that thing
120
How should a patient be positioned during feeding with a Dobhoff tube?
- NOT flat.
121
Can a Dobhoff tube be disconnected for ambulation/ mobility?
Yes. Check with nursing first.
122
What consideration should be given to a paitent recently post-op for a PEG/PEJ tube?
The area of insertion may be tender/ sore.
123
Can a PEG/PEJ tube be disconnected for mobility/ ambulation.
Yes.
124
What is a colostomy?
Fecal matter drains from the colon through the abdomen to be collected in a pouch.
125
Placement of what should be considered carefully in a patient with a colostomy?
Gait belt
126
What are hemodialysis and plasmapheresis?
- Removal of toxic waste from blood stream with renal failure to control fluid. electrolyte, and pH balance.
127
What lines are used hemodialysis and plasmapheresis?
Central venous lines or ateriovenous fistula.
128
How often and for long is hemodyalysis/ plasmapheresis done?
- Every other day for 3 - 4 hours
129
What is continous venovenous hemofiltration?
- Waste products continuously removed to prevent large fluid shifts
130
When is plasmapheresis indicated?
When the plasma cannot carry antibodies and nutrients to tissues/ remove wastes
131
What is plasmapheresis?
Blood cells are removed/ replaced
132
What measure should not be taken on an arm with AV shunt?
BP
133
What time management should considered with a patient receiving dialysis?
- Schedule treatment around dialysis treatments
134
How may a patient's treatment session be effected when the patient is not receiving dialysis at the time of treatment?
- May still have low endurance
135
Can a patient be treated if they are receiving CVVH?
Possible. Depends on placement of line and medical stability.
136
What is a foley catheter?
Placed directly into bladder to assist in evacuation of urine.
137
How can infection be avoiding when mobilizing a patient with a foley catheter? (3 points)
- Tape the tubing to the patients leg
- Keep the tubing clear of everyone's feet
- Keep the bag below the level of the bladder to prevent backflow.
138
What is an external ventricular drain?
- Tube placed into ventricles of brain to drain CSF to relieve pressure, blockage, etc.
139
Where should an external ventricular drain be placed?
External auditory meatus
140
What does an ICP monitor measure?
The pressure surrounding the brain.
141
What should be done with a patient with an external ventricular drain before mobility? Afterwards?
- Consult with MD to ensure ICP is controlled
- Clamp drain before mobilization
- Relevel drain before reopening after mobility
142
What pressure should be maintained when using an ICP monitor?
20 - 25 mmHg
143
How should the head be positioned with an ICP monitor?
- Bed in 30 degrees flexion at head
| - Head in neutral
144
What is a surgical drain?
Tube inserted into surgical site for draining.
145
How do most surgical drains operate? What are 2 specific methods?
- Suction mechanism
- Hemovac
- Jackson-Pratt drain (looks like grenade)
146
Can a patient with a surgical drain be mobilized?
- Yes
| - Pin drain to gown
147
What is a wound vac's 4 functions?
- Removes slough/ exudate from a wound
- Maintains moisture
- Increases circulation
- Reduces edema and bacteria
148
Can a patient with a wound vac be mobilized?
Yes, so long as there is enough battery power.
149
How should a wound vac be monitored?
Check for breaks in seal.
150
How should a wound vac be disconnected?
- Clamp boths ends
| - Clean both ends using a glove and gauze
151
What patients commonly wear compression boots?
Those at risk for DVT.
152
Can a patient with compression boots be mobilized?
- Yes
| - Remove before mobilization
153
If a patient is confused, are compression boots appropriate?
- No
| - Consider other methods of DVT control
154
If a patient is very edematous, what considerations should taken when using compression boots?
Use adjunct compression therapy to prevent pitting edema.
