Lines, Tubes and Drains

Question 1

What is a peripheral IV line?

Answer 1

allows continuous access to venous system for meds, fluids etc.

consider avoiding BP over IV site

Question 2

What is a PICC line?

Answer 2

peripherally inserted central catheter

inserts at: antecubital fossa/brachium

terminus: SVC

Question 3

What is important to remember about PICC?

Answer 3

no BP over picc or proximal due to risk of blood clot in vein or thrombophlebitis

Question 4

What is a Central venous catheter?

Answer 4

used for med, fluid administration that might not be able to go in smaller veins

higher risk of infection

Question 5

Where does CVC insert?

Answer 5

internal jugular, subclavian or femoral vein

terminates in SVC

Question 6

What is a non tunneled dialysis line?

Answer 6

quinton catheter- inserts in IJ, SC or femoral vein ends in central venous system

Question 7

What are PT implications of a non tunneled dialysis line in femoral vein?

Answer 7

suggested that hip flexion greater than 30 degrees and other activity limitations due to length of line

Question 8

What is a tunneled dialysis line?

Answer 8

longer term line with decreased risk of infection because line is tunneled beneath skin before entering vein

Question 9

What are PT implications for tunneled dialysis line?

Answer 9

if located in UE avoid extremes of ROM

Question 10

What is an Aline?

Answer 10

used for continuous blood pressure monitoring and ABG

Question 11

Where is insertion usually of a line?

Answer 11

radial, brachial or femoral artery

terminates: short line, so several cm into the artery

Question 12

What is a level transducer of an aline?

Answer 12

it measures the pressure and flushes system out

Question 13

Where is the level transducer located?

Answer 13

The phlebostatic axis is the reference point for zeroing the hemodynamic monitoring device.

Question 14

What are PT implications for an Aline?

Answer 14

range of motion may be limited at that joint and if you are mobilizing is that affecting the waveform of aline

Question 15

Can pts with a femoral a line mobilize?

Answer 15

yes as long as line is secure and pts hemodynamic response is appropriate

just be very careful

Question 16

What else can a central venous catheter do?

Answer 16

used with a transducer it can give central venous pressure and with other clinical signs can measure total body fluid balance

Question 17

What is important to remember about CVC numbers?

Answer 17

may not be useful or accurate during mobilization

Question 18

What is pulmonary artery catheter?

Answer 18

used to measure a variety of things like: CO, PA pressure, RA pressure, MVO2

Question 19

Where is insertion of PAC?

Answer 19

insertion: peripherally IJ, rarely SC and femoral
terminus: branch of pulm artery

level of transducer at phlebo axis

Question 20

What is a normal Central venous pressure?

Answer 20

2-5 mmHG

Question 21

What is normal right atrial pressure?

Answer 21

2-8 mm HG

Question 22

What is normal pulmonary artery pressure?

Answer 22

20-30 mmHG

Question 23

What is normal cardiac output?

Answer 23

4-8 L/min

Question 24

What is cardiac index ?

Answer 24

measures of heart performance, blood from left ventricle to body surface

norm: 2.6- 4.2 L/ min

Question 25

What is critical value for CI?

Answer 25

if less than 2.2 consider cariogenic shock

Question 26

What is a chest tube used for?

Answer 26

in plural space: the tube may remove air, blood or pleural fluid and/or infectious fluid in mediastinum: tube drains fluid, usually post cardio thoracic surgery

Question 27

Where is chest tube insertion?

Answer 27

through intercostal space and terminates or plural space or mediastinum

Question 28

What are three settings a chest tube can be on?

Answer 28

suction, water seal or clamped

Question 29

What are PT implications?

Answer 29

maintain drainage collection upright and below insertion level no restrictions on ROM switch from suction to water seal during mobility?

Question 30

When can there be an emergency with chest tube?

Answer 30

if there is a disconnect in system such as chest tube falling off

Question 31

What is an air leak?

Answer 31

when air comes through the chest tube to the collection system, can be normal during a pneumothorax

Question 32

What are three types of surgical drains?

Answer 32

blake, jackson pratt or hemovac

Question 33

What is an intra aortic balloon pump?

Answer 33

mechanical device used to decrease myocardial oxygen demand and increase coronary artery perfusion

Question 34

How does this device work?

Answer 34

inflates during diastole in coordination with the cardiac cycle, deflates during systole

Question 35

Where does ballon pump insert?

Answer 35

peripheral artery, usually femoral terminates: descending aorta

Question 36

What are PT implications for ballon pump?

Answer 36

most pts on this are on bed rest, no ipsilateral hip flexion greater than 30

Question 37

What is important to remember about a temporary pacemaker?

Answer 37

leads must be screwed in before mobility check orders from MD

Question 38

What kind of feeding tubes are temporary?

Answer 38

NG or NJ

Question 39

Which kind of feeding tubes are more permanent?

Answer 39

g tube or j tube inserted percutaneous to reduce risk of aspiration can lead to GI bleed, skin breakdown

Question 40

When is Total parental nutrition used?

Answer 40

reserved for patients who cannot use their GI tract due to dysmotility, ischemia, obstruction or surgery administered through venous access line

Question 41

What are two types of ICP monitors?

Answer 41

ICP bolt and ventriculostomy ( can CSF)

Question 42

What are PT implications for ICP?

Answer 42

watch for waveforms as this may be a sign of cerebral hypoxia or ischemia if ICP elevations over 5 mins notify RN keep HOB at 30 degrees

Question 43

What is an endotracheal tube?

Answer 43

temporary maintenance or airway potency and delivery of mechanical ventilation

Question 44

What is a tracheostomy tube?

Answer 44

"trach" inserted near thyroid cartilage and used for intermediate or permanent airway management

Question 45

Are trachs used with technical vents?

Answer 45

sometimes but not always

Question 46

How much air does a regular nasal cannula deliver?

Answer 46

can deliver between 0.25-6.0 L/min FiO2 increases by 4% liter per min

Question 47

What is a high flow nasal cannula?

Answer 47

up to 60 L/min FiO2- 21%-100% benefits: humidified, reduced entrainment of room air, can eat, drink talk easier than with a mask

Question 48

How much air can a simple mask deliver?

Answer 48

6 -10 L/min 35-50% fiO2 can't use with a trach

Question 49

What is a venturi mask?

Answer 49

provides .24-50% FiO2 useful for mobility if pt doesn't require more than 50% FiO2