Week 5 - tubes and elimination Flashcards
(19 cards)
Tracheostomy
“Trachs” - to maintain airway longer term
Do not touch or adjust ties
For SSN, take pic with “Trach in situ” instead
Likely nonverbal communication
Be aware of respiratory distress - mucus
EMERGENCY if it falls out
NG tube
Nasogastric tube - through nose and into stomach (for food in or to suck content out)
Attached to patient with nose clip and tape, and to gown. Find fastener before moving gown to scan - remove and refasten as needed
Keep head of bed up over 30 degrees
mouth breathing - give water for rinse and spit
Dislodged NG tube is NOT an emergency
Condom drainage
a catheter that goes outside the penis
Foley
Foley = indwelling urinary catheter
tube through urethra and into bladder
held in place by balloon
drained into bag
keep bag below the bladder - attach to leg, wheelchair, bed
be careful when transfer patient that bag comes too
if full, call RN to drain (infection risk if backs up)
NOT an emergency if disconnected
STERILE technique
Suprapubic catheter
inserted into bladder through surgical opening in abdominal wall
allows urine drainage if blocked urethra or no bladder
Ostomy
opening (stoma) in abdominal wall to allow feces to drain into collection pouch
NOT an emergency if disconnected
CLEAN technique
T-tube
T-shaped rubber tube that is inserted into CBD after gall bladder surgery (to keep CBD open). It is sutured to skin and connected to drainage bag.
Keep patient sitting up - low or semi fowler’s
If tube pulled out, apply pressure dressing and request analgesic (pain) - tube may need to be reinserted
Hemovac
Hemovac = portable wound suction
Evacuators are pinned to patients gown or attached to bed/stretcher - KEEP ABOVE drainage site
Watch for sudden massive discharge or bleeding - report immediately
closed chest drainage systems
for
1. drainage - to remove unwanted stuff (blood, air, extra fluid) from pleural space
2. reestablish negative pressure to help lungs expand
eg. water seal chest drainage
- air/fluid moves in 1 direction out of pleural space
- fluctuation in water-seal chamber means tube is in patient
Keep drainage system parallel to floor and below chest
EMERGENCY if tube falls out - plug hole in chest with something sterile (or clean)
EMERGENCY if tube becomes disconnected - clamp it
STERILE technique
Parenteral
introduce to body through a way other than the GI system
(eg. needles, IV, cannulas)
Peripheral line / Peripheral IV
attached to peripheral vein, small flexible tube in patient (rem, peripheral IV starts lab!)
short term
NOT an emergency if it comes out, cover with sterile guaze
Central line
Central line = CVC = percutaneous central venous catheter
attached to chest or neck and go directly to heart
usually anchored down with more than just tape (small grip on skin)
larger lumens than peripheral lines (may contain several small tubes - for noncompatible meds)
to deliver harsh meds (chemo) that would damage peripheral veins)
inpatient, often critical care
EMERGENCY if it dislodges
Central Venous Catheters
Different types: Central line, PICC, Hickman line, Port-A-Cath
ensure CVC tubing is always taped - be careful when moving
avoid scanning near dressing - keep dressing dry an intact
if CVC is leaking fluid - tell RN
if lumen is unclamped - turn to left side to prevent air entering venous sys and tell RN
if sudden increasing SOB = CODE BLUE
if CVC dislodges = CODE BLUE, cover with sterile gauze, lower head of bed
PICC
PICC = Peripherally inserted central catheter
inserted in arm, goes to SVC
may be outpatient
Hickman line
subcutaneous or tunneled central venous catheter
catheter tunneled subcutaneously under chest wall before entering SVC
may be outpatient
Port-A-Cath
Port-A-Cath = implanted vascular access
may be placed in chest, abd, or inner forearm
outpatient
permanent implant
IV pumps / EIDs
EIDs = Electronic diffusion devices
Alarm?
1. read message
2. try to fix it: patients arm extended? kinks in IV tube? pump plugged into wall?
3. press silence (to stop short term) or reset (if you fixed the problem)
error messages:
occluded - fix tube
infusion complete - no action needed
battery - plug in
air in line - not an emergency, pump stops, tell RN
PCA
PCA = Patient controlled analgesic pumps
IV in arm or epidural in back
**only the patient can push the button
(you can explain the exam and suggest a dose)
“Fracture” or “slipper” bedpan
narrow end under sacrum and open rim facing to foot of bed
- have patients raise hips
- or roll if immobile (or trapeze)
if possible, raise head of bed and knees up
leave room for privacy, bed rails up
remove bedpan (hold it firmly while patient gets off) - check with RN if monitoring outflow
