Acute Care Devices Flashcards
Things to decide with tubes/lines when entering the room
- 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
Feeding tubes are names by
insertion site to where they go
Nasogastric (NG tube)
TPN
- Percutaneous Tube
- PEG
- Need to be aware of gate belt placement
PT Implications - Feeding Tubes
- 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
Indwelling (Foley) Catheter and collection bag - Considerations
- 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
Condom (Texas) catheter and collection bag - considerations
- For use only with male patients
- Easy to remove accidentally
Surgical insertion - considerations
- Keep insertion site dry.
- Avoid placing gait belt over the insertion site.
Suprapubic and Indwelling Catheter - Considerations
- Collection bag with gravity drainage
Nephrostomy - Considerations
Tube goes to kidney; located in the back
Be careful with gait belt
Colostomy/Ileostomy and collection bag
- 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
Rectal Tube - Considerations
- 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.
The more central a lines is, the ____ critical its distrubance
more
What type of line is the most dangerous if dislodged?
Arterial due to higher pressures! Blood will pump out faster.
Cardiac Lead - Considerations
- 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
Periperal Intravenous (IV) Line
- 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.
Patient Controlled Analgesia via IV
- 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.
PICC - Considerations
- 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)
Arterial Line - Considerations
- 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
Pulse Oximeter - Considerations
- 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
BP Cuff - Considerations
- 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
Sequential Compression Device - Considerations
- 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!)
Endotracheal Tube - Considerations
- Inserted through mouth into trachea
- Avoid excess head and neck movement
Tracheostomy Tube - Considerations
- Small diameter tube inserted through neck into trachea
- Some functional mobility is possible
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
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
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
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!!!
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
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.
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
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
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!
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 andhealing status
- Be aware of wound / line location for gait belt placement / safety
- This is gold standard compared to e-stim with chronic wound.
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
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
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
Summary - Lines and Tubes
- Avoid extra tension on tubes / lines as they can easilybecome dislodged or malfunction
- Avoid placing gait belt directly on insertion site
- Watch cognitively impaired patients closely as thetendency 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 removedduring therapy session
- Can I do this alone?
