Tubes and Lines Flashcards
(122 cards)
1
Q
Arterial lines usually placed where
A
femoral, radial, or brachial arteries
2
Q
Arterial line permits what
A
repetitive arterial blood samples
3
Q
Arterial lines measure what
A
arterial blood pressure
4
Q
Most accurate readings from arterial lines are in what position
A
limb straight and level with the heart
5
Q
Normal for systolic and diastolic for arterial line readings
A
Sys = 80 to 180 Dias = 40-110
6
Q
What to keep in mind with femoral arterial line (ROM restriction)
A
no hip flexion past 45 degrees with rigid one
7
Q
Therapist implications - arterial line
A
Avoid kinking off
Turn only 90 deg in SL
Careful ROM to prox joints
8
Q
Central venous catheter - inserted most commonly through what
A
subclavian vein
internal jugular
femoral vein
9
Q
Tip of the central venous catheter enters what
A
the SVC
10
Q
Central venous catheter measures what
Provides info about what
A
right arterial pressure
About the body’s volume status and RV function
11
Q
Normal central venous catheter findings
A
0 to 6
12
Q
What are long term central venous catheters called
A
Hickman Groshong catheters
13
Q
Therapist implications with central venous catheter
A
Dont roll patient to side catheter is on - might cause PVC
14
Q
Triple lumen
A
IV lines that emerge into one main vein
Provides access to pt for large dose of meds, fluids, and blood for parenteral nutrition
15
Q
Pulmonary artery catheter AKA
A
Swan Ganz
IS YELLOW!
16
Q
Pulmonary artery catheter is passed through where
A
the right side of the heart into a pulmonary branched vessel
17
Q
Pulmonary artery catheter provides what
A
an immediate profile of cardiac function by measuring pulmonary artery pressure and CO
18
Q
Pulmonary artery catheter approximates
A
left ventricular end - diastolic pressure - preload
19
Q
Normal measure for pulmonary artery catheter
A
5-15 mmHg
20
Q
Precautions with measure of pulmonary artery catheter greater than 12mmHg
A
do not place them in a horizontal position because venous return will increase
21
Q
Therapist implications with PA catheter - these patients are frequently
A
restricted to bed rest because of risk of pulmonary thrombosis, jugular vein thrombosis, PA rupture, hemorrhage, sepsis and arrhythmia
22
Q
Peripherally Inserted Central Catheter (PICC) provides what
A
alternate means of vascular access
23
Q
PICC - use is long or short term?
A
Can be used short or long term
24
Q
PICC - can it be used at home
A
Yes, appropriate for home IV therapy
25
PICC - catheter is inserted by
venipuncture of the basilic, medial cubital or cephalic vein, at or above the antecubital space
26
PICC - tip advances to where
lower 1/3 of SVC
27
How can you tell if patient has a PICC - description
Tiny - has blue of white butterfly taped down
28
Therapist implications with PICC (ROM)
Do not flex shoulder or elbow more than 90
Could cause arrhythmia
Avoid dislodging
29
Intravenous catheters are used for what short term
to provide short term access into the body for blood products, IV fluids, and meds
30
Intravenous catheters are used for what long term
access for IV antibiotics, total parenteral nutrition, dialysis or chemo
31
Intravenous catheters will monitor what
central venous pressure or right atrial pressure, pulmonary artery pressure, wedge pressure, and temperature
32
Midline catheter - description
looks like PICC line but is not sutured in like the PICC line is
33
Midline catheter is usually located
in the antecubital fossa
34
Intravenous catheter - methods of placement - PICC, midline, IV lines placed by who
Nursing or IV team
| PICC and midline are xrayed after
35
Intravenous catheter - methods of placement - Hickman, Swan Ganz, and central venous lines are usually placed by who
physicians at bedside, stitched into place and then x-rayed after placement
36
Therapist implications with IV catheter
No BP in that extremity
| Do not dislodge
37
Peripheral IVs - long or short term use
short term use 24-48 hours
38
Peripheral IVs - placed where
anywhere from hand to upper arm to feet and thighs
39
Therapist implications for peripheral IV
Do not dislodge
No BP in that extremity
Cautious with elbow flexion
40
Intravenous pumps - common alarms
Low battery
Occlusion
Air in line
Infusion complete
41
What to do with lwo battery alarm
plug into wall outlet
| Loses all settings if battery dies
42
What to do with occlusion alarm
Adjust the line and stop mvmnt to stop occlusion
| Push appropriate channel and then push start
43
What to do with air in line alarm
contact the nurse
44
what to do with infusion complete alarm
contact nurse immediately
| IV can clot in 4 minutes
45
IV pump - what to do if hub of catheter and tubing is leaking
Twist two components together and notify nursing
46
What to do if tubing has become detached
Hit pause and notify the nurse
47
What to do if IV has been pulled out of IV site
Apply firm pressure with gloved hand and gauze
| Turn off IV and notify RN
48
What to do if piggyback (bag) is leaking
clamp it off and notify nurse
49
Intracranial pressure monitoring
ICP bolt or ventriculostomy
| CPP (cerebral perfusion pressure)
50
ICP bolt or ventriculostomy reflects what
the dynamic pressure relationship between the brain, CSF, and cerebreal circulation
51
Normal ICP bolt or ventriculostomy finding
0-15mmHg
Above 20 is critical
Normal waveform have 3 peaks
52
In an unimpaired brain - high ICP results in
automatic protective responses in an effort to maintain equilibirum
53
When an ICP continues to rise despite the brain's attempt to alleviate it 0 what happens
intracranial hypertension
54
Uncontrolled intracranial hypertension results in what
secondary cerebral ischemia, brain herniation, and ultimately death of neural cells
55
Anatomic ICP device positions include
subarachnoid space
epidural space
intraventricular space
intraparenchymal space
56
ICP bolt vs. Camino bolt
ICP bolt you can work with
| Camino bolt you cannot
57
CPP is a value that considers
both MAP and the intracranial pressure
58
MAP
the ability of the body to deliver blood to the brain
59
Intracranial pressure
the resistance the system pressure must overcome to profuse the brain
60
Normal CPP
60-150 mmHg
61
CPP is calculated by
subtracting ICP from MAP
62
Therapy implications with CPP
DO NOT move the bed or perform bed mobility and transfers w/o having the nurse clamp the drain
Supine exercises in stationary position are ok
63
Intraaortic balloon pump (IABP) - inflates and deflates when
inflates in diastole, deflates in systole
64
IABP assists with
circulation of blood through the body and reduces work of the heart
65
Therapist implications with IABP
Strict bedrest
log roll only
No hip flexion on the side the apparatus is in
66
Pacemaker and defibrillator consists of what
placing unipolar or bipolar electrodes on the myocardium to assist with control of arrythmias
67
Pacemaker used when
chronic dysrhythmias
68
AICD used when
life threatening arrhythmia
69
Temporary pacemaker
temporary pacing after heart surgery
70
Therapist implications for pacemaker or defibrillator
No shoulder flexion above 90 degrees
Exercise limitations for UE use
No BP on that side
71
Ventricular assist device - what is it
surgically implanted mechanical device that helps the heart pump blood
72
Ventricular assist device - used for what patient population
advanced heart failure
73
Therapist implications with VAD
```
warm up and cool down
plug in when possible
no exercise above 90 degrees
progressive ambulation
no contact sports or activities
avoid simultaneous bilateral shoulder flexion, abduction more than 90 degrees
```
74
Indications for chest tubes
Pneumothorax
Hemothorax
Empyema
Pleural effusion
75
Precautious with chest tubes
Avoid kinking off
Disconnecting from suction - check with nurse
Keep collection chamber dependent
76
Therapist implications for chest tubes
Observe quantity of drainage, notify nurse if excessive
pt can be turned and mobilized after proper tube placement
MD clearance needed to disconnect from suction
UE ROM can be safely performed
77
Feeding tubes - types
```
1 Nonvented single and vented double lumen tubes
2 Nasogastric tube
3 PEG
4 Gastrostomy
5 Jejunostomy
```
78
Feeding tubes - Nonvented single and vented double lumen
preferred for enteral feedings
79
Feeding tubes - nasogastric tube -
inserted initially - when patient requires nutrition for longer than 3-4 weeks, long term enteral access needed
80
Feeding tubes - PEG (percutaneous endoscopic gastrostomy)
Used when long term enteral nutrition is needed
81
Feeding tubes - gastrostomy
allows easy access for meds
| can be replaced by family and patient
82
Feeding tubes - jejunostomy
provides reduced risk for aspiration for those w/o gag reflex
Can feed immediately post op
Can be replaced by patient and family
83
Therapist implications with feeding tubes - gastric bolus feedings - wait how long
15 to 20 minutes before placing head down flat
84
True or False - all feeding tubes can usually be disconnected for the patient to be immobilized
TRUE
85
Continuous feedings - wait time
none
86
Feeding tube should be placed on hold or turned off when patient is below __ and restarted when patient is brought back up above ___
30 degrees
87
Drains - Jackson Pratt
self contained low pressure drain with compressed bulb that expands slowly creating suction
88
Drains - Jackson pratt - commonly used to
eliminate air or blood from the abdominal cavity or drain blood from the skull
89
Drains - Hemovac
Another low pressure drain that is initially decompressed and then expands slowly to create suction
90
Drains - hemovac - commonly used for
TKA and THA to drain blood
91
Therapist implications for drains
Avoid dislodging or pulling out
| Clip to patients gown or clothing to dec tugging on the site
92
Dialysis is the process of
separating elements in a solution by diffusion across semipermeable membrane
93
Types of dialysis
Peritoneal
Hemodialysis
Hemofiltration
94
Hemodialysis
process by which a man made membrane helps to clear wastes from the blood, eliminate extra fluid and restore the proper balance of electrolytes
95
Hemodialysis - catheter is inserted into
the internal jugular, subclavian or forearm for fistula (more long term access)
96
Hemodialysis - lasts how long
3-5 hours
97
Hemodialysis - blood is
removed, filtered, and reinserted
98
Peritoneal Dialysis - used for those who
cannot tolerate the BP shifts from hemodialysis and is less taxing on the body
99
Peritoneal dialysis - catheter is inserted
into the peritoneum and has a double cuff that seeds itself into the abdominal wall
100
4 kinds of peritoneal dialysis
Intermittent (IPD)
Continuous Ambulatory (CAPD)
Cyclic continuous (CCPD)
Equilibrium (EPD)
101
Intermittent Peritoneal Dialysis
warm dialysate is infused rapidly, allowed to dwell, and then drained
Each cycle is 10 min
Lasts 8-48 hrs, 3-7 days
102
Continuous ambulatory dialysis
infused (10 min) allowed to dwell (4-8 hrs) and then drains (10 min)
Lasting 3-4 times per day, 1 night
103
Advantage to CAPD
Closely approximates the normal functioning homeostasis
| No special equipment needed
104
Cyclic continuous peritoneal dialysis
Combination of IPD at night and CAPD during the day
Lasting 3-4 times per night lasting 8 hours
Dec chance of infection
105
Equilibrium peritoneal dialyssi
continuous - for hospitalized, non ambulatory patients
106
Complications of peritoneal dialysis - mechanical
Perforation of viscous, leakage, clots and obstruction of flow
107
Complications of peritoneal dialysis - infection
peritonitis, infection of skin interface and catheter
108
Complications of peritoneal dialysis - Cardiovascular
HTN, pulmonary edema, arrhythmias
109
Complications of peritoneal dialysis - Pulmonary
Atelectasis, pleural effusion, pneumonia
110
Complications of peritoneal dialysis - Metabolic
hyperglycemia, hypoalbuminemia
111
Complications of peritoneal dialysis - Misc
seizures, electrolyte disorders, peritoneal sclerosis, hypothyroidism
112
Therapist implications with dialysis
Avoid dislodging or pulling out
Dont flex hip more than 45 if femoral port
Bed may need to be elevated to allow for dependent drainage
113
Therapist implications with dialysis - pt may exerpience
fatigue, dehydration, electrolyte imbalance
| Long term - joint swelling, subchondral bone cysts, chronic arthralgias, muscle cramps
114
Hemofiltration dialysis
dilutes blood and decreases blood serum
| Often used in conjunction with hemodialysis
115
Four kinds of hemofiltration
CAVHD
CVVH
CVVHD
CVVHDF
116
Hemofiltration - CAVHD - Continuous arteriovenous hemofiltration - inserted where
Inserted in subclavian, jugular, femoral veins
117
CVVH - continuous veno venous hemofiltration - functions hwo
removes mid sized molecules
improves sepsis and volume overloaded patients
Replacement electrolyte soluation is required to maintain hemodyanmic stability
118
CVVHD - continuous ven venous hemodialysis
continuous diffuse dialysis
119
CVVHDF!!! - Continuous veno venous hemodiafiltration
Mos tpopular in ICU
Combines convective and diffuse dialysis
Both small and middle sized molecules are cleared
Dialysate and replacement fluids are required
120
Urinary catheter and renal catheter AKA
foley catheter
121
Urinary catheter is held in with
a bulb
122
Therapist implications with foley catheter
dont hold line or bad above insertion site
dont dislodge tube
clip catheter to patient clothes
rectal - be careful not to sheer on surface they are on
