Acute Care Devices Flashcards
1
Q
Things to decide with tubes/lines when entering the room
A
- Can I mangage all these lines and tubes myself
- Do I need help
- I have never seen this tube, I need to ask someone first
- Move the lines to the side of mobility
2
Q
Feeding tubes are names by
A
insertion site to where they go
3
Q
A
Nasogastric (NG tube)
4
Q
A
TPN
5
Q
A
- Percutaneous Tube
- PEG
- Need to be aware of gate belt placement
6
Q
PT Implications - Feeding Tubes
A
- NG feeding tubes should be stopped and patient positioned upright got 30 minutes (1 hour in pediatrics) before supine activites (Patient should not lie flat)
- Some patients have continuous feeding nutrition, need IV pole along with you for transportation and/or gait activities
- May be able to have tube disconnected, contact nurse to do
- Be aware of gait belt placement with PEG tube
7
Q
Indwelling (Foley) Catheter and collection bag - Considerations
A
- Keep collection bag below bladder level.
- Avoid tension on tubing.
- Drain urine from tubing before activity; you may have to drain collection bag – MUST measure and document and/or inform nurse
8
Q
Condom (Texas) catheter and collection bag - considerations
A
- For use only with male patients
- Easy to remove accidentally
9
Q
Surgical insertion - considerations
A
- Keep insertion site dry.
- Avoid placing gait belt over the insertion site.
10
Q
Suprapubic and Indwelling Catheter - Considerations
A
- Collection bag with gravity drainage
11
Q
Nephrostomy - Considerations
A
Tube goes to kidney; located in the back
Be careful with gait belt
12
Q
Colostomy/Ileostomy and collection bag
A
- Attached directly to the large intestine through surgical opening in abdomen.
- Bag may need to be emptied prior to mobility (patient or nurse)
- Maintain secure attachment of bag.
- Keep bag attachment dry.
- Be aware of gait belt placement.
Stoma is opening; ostomy pouch
13
Q
Rectal Tube - Considerations
A
- Inserted into rectum with collection bag.
- Can easily become dislodged.
- Keep bag below level of tube.
- Use “slippery sheet” for mobility activities.
- Patients may be uncomfortable in seated positions.
14
Q
The more central a lines is, the ____ critical its distrubance
A
more
15
Q
What type of line is the most dangerous if dislodged?
A
Arterial due to higher pressures! Blood will pump out faster.
16
Q
Cardiac Lead - Considerations
A
- Monitor heart activity.
- Alarm may sound if lead is dislodged, or the sensor pads are not fully adhered.
- Attached to TV / monitor in critical care; coordinate with nurse to connect to portable telemetrydevice formobilityactivities
17
Q
Periperal Intravenous (IV) Line
A
- For administering medications and fluids
- Typically, in peripheral vein on forearm or back of hand; also, neck, leg, or foot
- Avoid blood pressure (BP) cuff on limb with IV.
- Maintain drip bag above insertion site.
- Avoid occluding or placing tension on the line.
- Notify nursing staff if insertion site is swollen or red.
18
Q
Patient Controlled Analgesia via IV
A
- Patient uses push-button to deliver pain medication through IV via electronic pump. Almost instant relief.
- Total amount is controlled to prevent overmedication.
- Typically seen immediately post-surgically with weaning process to oral medications
- Avoid occluding tubing; alarm may sound
- Coordinate mobility activities with pain control
- Ensurepush-button is within patient reach at end of session
- When it pops up green the patient will be able to give themselves another dose
- PT is NOT allowed to press the button; you can only notify them that it may be beneficial to hit it.
19
Q
PICC - Considerations
A
- Inserted in vein of upper extremity, terminating in superior vena cava
- Allows for administering drugs and fluids long term
– Chemotherapy
– Dialysis treatments - Avoid placing a BP cuff on arm with PICC.
- Use of axillary crutches may be contraindicated (if placed in basilic vein)
20
Q
Arterial Line - Considerations
A
- Thin catheter inserted into artery BP and connected via pressure tubing to external transducer
- Location of transducer related to heart can alter readings
- Femoral insertion requires hip flexion range of motion (ROM) restricted to 60° to 80°; more often, nurses will prefer that you do not perform hip ROM when present. (Femoral Artery Line); Period of time they must remain in bed for incision site for typically an hour; Specific to extremeity
- Displacement of an arterial line is a life-threatening emergency! Apply pressure to the insertion site and call for help.
- Often laying in bed with the patient
21
Q
Pulse Oximeter - Considerations
A
- Can also be on earlobes, big toe, finger
- Raynauds patients will likely have it on the earlobe
- Check with nurse to see if you need to have a portable O2 device with you
22
Q
BP Cuff - Considerations
A
- If you want to get patient up and moving you need to have a means of being able to measure it.
- Portable monitor or doing manual BPs during exercise
23
Q
Sequential Compression Device - Considerations
A
- Sleeves placed on patients legs and attached to inflation pump
- Compression is graduated distal to proximal to return venous blood to heart
- Can be removed for mobility (Exercise preceds these!)
24
Q
Endotracheal Tube - Considerations
A
- Inserted through mouth into trachea
- Avoid excess head and neck movement
25
Tracheostomy Tube - Considerations
* Small diameter tube inserted through neck into trachea
* Some functional mobility is possible
26
Ventilator - Considerations
* Machine-assisted breathing device connected to tracheal tubing
* Alarms may sound; check with nurse for meaning (not always critical alarms)
* Some out-of-bed activity is possible
* **Displacement of the ET tube creates a life-threatening situation for the patient.**
* **Check for changes in insertion level (marked by line on tube) of tube before and after activity; contact nurse when needed**
27
Ventilator Setting Values
PEEP (assists with aveloi opening)
* Normal = 5 cmH2O
FiO2 (Fraction of inspired oxygen)
* Normal: Less than 60% in order to prevent oxygen toxicity
28
Ventilator Modes
**AC (assist control) or CMV (continuous mechanical ventilation)**
* Most common
* Full ventilator support
* Inspiration is triggered by ventilator
* Additional breaths by patient are at a fixed Tidal Volume
**SIMV (Synchronized Intermittent Mandatory Ventilation)**
* Not full ventilator support
* Set Rate and Volume
* Spontaneous breaths synchronized with ventilator breaths
* Patient inspiratory efforts above set Rate are unassisted
**PS (Pressure Support) - popular weaning mode as patient does some of the work**
* All breaths spontaneous by patient (no Rate setting)
* Ventilator delivers a set Pressure (high pressure = bigger breaths)
* As the Pressure is modified, the spontaneous respiratory rate and tidal volume adapt (alarms set to indicate volumes that are too high or low)
* PEEP
29
Cannula and Masks
* Nasal cannula
-- Typically 1-4 L O2
-- Be sure it is aligned with nostrils
* Mask for higher flow
* **Check levels of oxygen on portable O2 containers before use**
* Check with medical chart / nurse / respiratory therapist regarding oxygen titration parameters
-- **DO NOT titrate without orders!!!**
30
Capnography
* Looks for respiratory depression; Too depressed means they may need to change medication as it is altering there respiration.
* Utilized to monitor ventilation for the patient during **pain management with the use of narcotics** (post-surgically)
* Narcotics have the potential to increase respiratory depression
31
NG Suction Device - Considerations
* Flexible tube inserted via nasal passages and attached to a wall suction device to remove stomach contents
* Discuss with RN if tubing can be disconnected and capped for mobility
* Darker colored; Looked like Nasogastric tube. Goes into filling device on wall.
32
Jackson Pratt (JP) drain
* Tubing from surgical site to suction bulb; **Wound drainage**
* Drains and collects excess fluid from surgical site
* Drain usually **attached** to patient’s clothing **via safety pin**
* **Have nursing staff drain before the activity if more than half full**
* **Be careful with gait belt placement**
33
Hemovac
* Wound drainage
* Tubing from surgical site to collection canister
* Drains and collects excess fluid from surgical site
* Drain usually attached to patient’s clothing via clip
34
Chest Tube - Considerations
* Large-bore tube inserted into chest cavity
-- Mediastinal (12-24 hours post-operative)
-- Pleural (1-3 days post-operative)
* Drains excess fluid or maintains pulmonary inflation
* Tube attached to wall suction unit or water-sealed bedside container
* Keep bedside container upright and below insertion site
* **Do not place gait belt over or under chest tube site; Go under the armpits**
* **Accidental removal of chest tube is a life-threatening emergency!**
35
Wound VAC
* For large non-healing wounds or pressure ulcers, diabetic ulcers
* **Can be placed anywhere on the body**
* Surgically placed sponge (blue part) with negative pressure vacuum suction to cannister
* Brings blood and tissue to the area
* Vacuum device can run on battery power, making mobility possible
* Dressing replaced every 24-72 hours depending on drainage and healing status
* Be aware of wound / line location for gait belt placement / safety
* This is gold standard compared to e-stim with chronic wound.
36
Ventriculostomy
* For drainage / sampling of CSF and monitoring ICP
* **Drainage dependent on patient position** relative to tubing and collection device
* **Head of bed should be elevated 30 degrees with unclamped tube**
* **Prior to moving the patient, the drainage tube should be clamped**; check with nursing
* Monitor **color** changes in CSF; **normal** would be **clear or straw-colored**; blood presence would be abnormal
* **With mobility, monitor for signs of increased ICP**
-- Nausea, vomiting, dizziness, headaches, blurred vision, decreased alertness, confusion, weakness, problems talking
37
Intracranial pressure (ICP) monitor
* Device that measures pressure within the brain via a small catheter attached to a sensor placed in the epidural space or in the ventricles of the brain
* **Always contact nursing before activity**
* Maintain **neutral head position**
* Brain is **very sensitive to pressure changes** (coughing, Valsalva, agitation, pain, and activity)
* **Change in bed height and head of bed position can alter transducer reading**
38
Ventricular Shunt
* Tube surgically placed into the ventricle of the brain to shunt excess cerebrospinal fluid (CSF) from the brain to the jugular vein or abdominal cavity
* **Bed rest for 24 hours after shunt placement**
* **Avoid direct pressure** over shunt
* Watch for **severe headache or nausea** upon sitting or standing; report to nursing staff
* VP: ventriculoperitoneal shunt
* VA: ventriculoatrial shunt
39
Summary - Lines and Tubes
* Avoid extra tension on tubes / lines as they can easily become dislodged or malfunction
* Avoid placing gait belt directly on insertion site
* Watch cognitively impaired patients closely as the tendency can be to pull at tubes / lines
* Check orders and/or with nursing to see if tubes / lines can be disconnected
* Notify nurse if a tube dislodges or a line is removed during therapy session
* Can I do this alone?
