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Pt Care 2 > Advanced Medical Accessory Equipment > Flashcards

Advanced Medical Accessory Equipment Flashcards

1
Q

List the three reasons a nasogastric (NG) tube would need to be inserted (uses)

A

Feeding, decompression, radiographic examination

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2
Q

In which modality would an NG tube be inserted to optimize the images

A

CT

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3
Q

Name the two types of NG tubes used for decompression

A

Levin and Salem-Sump

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4
Q

Name the nasoenteric (NE) tube which promotes peristalsis

A

Miller-Abbott

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5
Q

Explain the rationale for performing a chest x-ray on a patient who recently had an NG tube inserted.

A

To confirm the placement of the NG tube PRIOR to administering any nutrients etc.

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6
Q

Are the electrocardiogram (ECG) leads placed on the ribs or the intercostal spaces and why?

A

Intercostal spaces because bone causes artifact

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7
Q

List the three classifications of central venous catheters (CVCs).

A

Short or Long term, non-tunneled, external catheters
Long-term, tunneled, external catheters
Long-term, implanted infusion ports

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8
Q

What is the purpose of a Groshong catheter?

A

It’s used for delivering medications/fluids and for withdrawing blood

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9
Q

Which healthcare provider can access CVCs?

A

Only specially trained personal are permitted to access CVCs. Nurses with additional training.

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10
Q

List the locations where CVCs can be inserted.

A

Subclavian vein
Femoral vein
Basilic or cephalic vein in arm ( PICC lines)

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11
Q

Alternate name for Swan-Ganz Catheter? What category catheter is it considered?

A

Pulmonary Artery Catheter (PAC)

Considered a CVC or central line

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12
Q

How many lumens can a Swan-Ganz catheter have? What can it be used to do?

A
  • up to 4 lumens

Can be used to:

  • Measure cardiac output
  • Measure right heart pressures
  • Indirectly measure the left heart and lung pressures
  • Diagnose right and left ventricular failure
  • Monitor specific medications
  • Assess effects of stress and exercise on heart function
  • Measure core temperature
  • Reveal the amount of oxygen left in the blood after it has circulated through the body
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13
Q

How does a Swan-Ganz cath do its thing?

A

uses a balloon to carry it through the heart to a pulmonary artery; when it is positioned in a small arterial branch, pulmonary wedge pressure is measured in front of the temporarily inflated and wedged balloon

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14
Q

Where might you see a Swan-Ganz catheter?

A
  • Often seen in ICU or CCU patients who require intensive monitoring
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15
Q

CVCs - what are they and what are alternate names

A
  • Central Venous Lines AKA Central Lines
  • All CVCs are catheters that provide access to the circulatory system on a repeated or continuous basis.
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16
Q

Functions of CVCs?

A
  • Administer chemotherapy or other long-term drug therapy
  • Provide total parenteral nutrition (bypassing the alimentary canal)
  • Dialysis
  • Blood transfusion
  • Facilitate the drawing of blood for lab analysis
  • Allow venous pressure monitoring
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17
Q

What differentiates a tunneled CVC from other types?

A
  • designed to be more long-term
  • inserted into incision in chest
  • tunneled through fatty tissue
  • threaded into vein in neck & advanced to vena cava
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18
Q

common characteristics of CVC’s?

A
  • Constructed of special material that provides the needed rigidity for placement and lowers the incident of blood clot formation (which is a complication of CVCs).
  • Radiopaque strips or radiographic distal ends allow radiographic verification of CVC placement.
  • Can be either single or double lumen.
  • The distal tips of all CVCs rest in the vena cava near the right atrium of the heart.
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19
Q

Where do non-tunneled CVCs get placed?

A
  • Subclavian vein
  • Internal/external jugular vein
  • Femoral vein
  • Basilic or cephalic veins in arm (PICC lines)
20
Q

Complications of CVCs

A
  • Clotting
  • Local inflammation or phlebitis
  • Systemic infarction
  • Venous thrombosis
  • Air embolus
  • Extravasation of medication
  • Migration of catheter (moves from intended location)
21
Q

True of false: MRT can insert, use, care for CVCs

A

false.

ONLY specially trained personnel are permitted to use or care for them. Nurses take additional training to handle CVCs

22
Q

Proprietary names of CVC and their characteristics:

A
  • Hickman- long-term use, used for administering medication, withdrawing blood and measuring central venous pressure
  • Groshong- single/double lumen catheter used for delivering medication/fluids and withdrawing blood
  • Raaf- large, double lumen used for dialysis
  • Port-a-cath-infusion port or venous access port
  • PICC-peripherally inserted CVC for short- or long-term use, inserted through vein in arm (at or superior to the subcubital fossa)
23
Q

Patients who may require an NG tube for feeding include those affected by:

A
  • Trauma
  • Disease
  • Altered state (i.e., drug overdose)
  • Surgical procedure (e.g., tracheostomy prevents normal swallowing)
24
Q

Patients who may require an NG tube for decompression include:

A
  1. Patients who require removal of gas and secretions by suction
    * Used to prevent vomiting in patients who have recently had surgery
25
Q

How/why might NG tubes be used for a radiographic exam?

A
  • Contrast is injected by hand with a syringe into the existing NG tube, in the x-ray department under fluoro with a radiologist.
  • Oral contrast may also be given using existing NG tube to patients who need to be prepped for their CT scan.

if patient cannot swallow or is post anaesthetic, can be used to admin contrast

26
Q

Types of NG tubes:

A
  • Dobbhoff – The most commonly used NG tube for feeding.
  • Levin – One of the most commonly used NG tubes for decompression. It has a single lumen and several holes near its tip.
  • Salem-Sump – Another commonly used NG tube for decompression. This tube is a double lumen. One lumen is used to remove gastric content and the other functions as an air vent.
27
Q

Reasons for using an NE tube instead of an NG tube include:

A
  • A decrease or absence of peristalsis in the stomach but not the intestines
  • Delayed gastric emptying
  • Patient has had a gastric resection
28
Q

Types of NE tubes:

A
  • Miller-Abbott – Double lumen tube. One lumen is for drainage and the other is for a balloon. The balloon is weighted to simulate a bolus of food and promotes peristalsis to advance the tube into the small intestine.
  • Harris – Single lumen with one opening
  • Cantor – Single lumen with one opening
29
Q

NE tubes are demonstrated using radiography how?

A

If the NE tube is difficult to advance, the use of fluoroscopic equipment may my used.

30
Q

Why is a conventional radiograph taken after the insertion of the NG or NE tube? What are important considerations/ modifications for the exam?

A
  • taken to confirm the tube placement. This is important to ensure food is not administered into the lungs or that the tube has not curled or kinked onto itself.
  • IR in portrait/ upright position!
  • IR somewhat more inferiorly placed than usual
  • consider adjusting technical factors to patient to visualize ng tube
  • A CXR or single view of the abdomen will be ordered to confirm NG or NE placement, so ensure you centee accordingly!!!
    • Need to modify or adjust the centering point to include the radiopaque tip of the NG tube.
  • Read the history on the requisition indicating the reason for the exam.- will get handling cues from there
  • pin for tube on gown will cause artifact- carefully move pin location to shoulder out of the way
31
Q

What’s an ECG/EKG do? What is it’s reading called?

A

Monitors electrical activity of the heart

electrocardiogram (also ECG or EKG)

32
Q

Where is continuous ECG monitoring standard practice? Who might also arrive to DI sept attached to one?

A

most critical care units

Patients from ER who suffer from various acute medical problems (such as angina or arrhythmia) or patients with traumatic problems may also come to the DI dept. while connected to an ECG monitor.

33
Q

When might ECG’s be ordered related to radiography?

A

during special imaging procedures or treatments to closely watch the patient’s cardiac function.

34
Q

what are ECG electrodes? What care should be taken with them, generally?

A

ECG electrodes are electrical contacts that can receive tiny electrical signals produced by the patient’s heart. The electrodes are incorporated into disposable adhesive patches attached to the patient’s skin. It is essential that the cables and electrodes patches remain secure.

35
Q

How should patients with ECG setups be handled in DI dept.?

A
  • IF NOT CONNECTED TO THE MONITOR, leads can be temporarily disconnected from electrode patches
    • electrode patches left in place on patient’s chest
  • IF CONNECTED TO THE MONITOR, DO NOT REMOVE LEADS OR PATCHES, drape wires over shoulders out of the way
  • although the patches produce minor metallic or plastic artifacts on chest radiograph, not necessary to remove them unless ordered to do so by physician
  • leaving patches in place saves time if monitoring must be resumed on an emergency basis and saves expense of replacing patches.
  • if any leads or wires come off the patient, put ‘em back! also after exam, leave patient as you found ’em
36
Q

What equipment comprises ECG setup?

A
  • Electrodes/leads – most ER patients will have a 3 lead placement but there are also 12 lead placements
  • Cables/wires
  • Electronic display unit/monitor
37
Q

Where do ECG leads get placed on pt?

A
  • Two leads are placed on the anterior part of the chest on each side of the sternum at the level of the 2nd intercostal space. These should be on soft tissue, so avoid bone if possible.
  • The third lead is attached on the side of the chest at the level of the sixth or seventh intercostal space.
  • The white lead goes on the right side, the black lead goes on the left side and the green lead goes on the side of the chest.
38
Q

if the connected ECG starts screaming while you’re doing a mobile exam, what do?

A
  • stop exam
  • check the leads- did one just come off? if so, reconnect it!
  • it that’s not it, get your equipment out of the way and get help. do not resume exam until patient is stable enough to handle it
39
Q

what does patient movement when an ECG is being performed cause?

A

abnormal tracing

40
Q

Indications for Chest Tube Insertion and causes:

A

Prevention and treatment of:

  • Hemothorax – Accumulation of blood in the pleural cavity
  • Pneumothorax – Accumulation of air or gas in the pleural cavity

These conditions can be caused by illness or injury, or as a result of a thoracotomy procedure, which is the surgical creation of an opening into the chest cavity. Thoracotomies are performed to diagnose or treat disease or injury to the lungs or pleura.

41
Q

chest tube: equipment and purpose

A

The water-sealed drainage system is established by connecting the chest tube that originates in the pleural cavity to a clear tube that ends in a chamber containing sterile water or sterile normal saline solution.

Water-sealed drainage unit removes any air or fluid from the pleural cavity. This is done to reestablish the correct intrapleural pressure and to allow the lungs to expand normally

42
Q

8 pt care precautions with chest tubes:

A
  1. gloves
  2. drainage unit remains below pt chest level (much like urinary catheter- fluid dynamics)
  3. keep tubing from pleural cavity to drainage chamber as straight as possible. If too long, loosely coil on pt’s bed or by wheelchair
  4. connections tightly taped to tubing. NEVER CLAMP
  5. do not empty chambers or raise above insertion site
  6. if water sealed chamber is bubbling continuously notify nurse immediately, may indicate a leak . There should be a steady rise and fall of the water as pt breathes.
  7. do NOT allow tension to be placed on the chest tube or the patient to be positioned in a way that causes the tubing to be kinked or sealed off. Drainage tube should be long enough for free movement
  8. Disturbance of the tube at either end (tube to skin or tube to drainage system) may result in a rush of air into the pleural space, reversing the intent of the treatment and potentially causing a collapsed lung. (many fucking yikes)
43
Q

where’s a chest tube go in?

A
  1. To remove air or gas (pneumothorax), the tube is inserted through the ANTERIOR and SUPERIOR surface of the chest wall.
  2. To remove fluid/blood (hemothorax), the tube is inserted through the POSTERIOR and INFERIOR surface of the chest wall.
44
Q

Could the DI Dept be a location where a chest tube needs to be inserted? If so, under what circumstances?

A
  • Yep
  • during a thoracic cavity biopsy in CT, it is possible that an artery could be nicked and cause a hemothorax, or a pneumothorax if a lung collapses
  • radiologist would be responsible for insertion
45
Q

Process for chest tube insertion?

A
  • freezing occurs at surface
  • Radiologist marks location
  • makes small incision
  • uses increasing size dilators until cut is big enough
  • guide wire threaded through dilator
  • dilator slides off
  • feed catheter over guide wire to pleura
  • pop through to cavity
  • air or blood starts comin out
  • connects insertion tube
46
Q

more handling of chest tube equipment

A
  • water sealed drainage unit has feet!
  • waterproof tape use to connect tube to tube and tube to patient
  • if you see flesh coloured tape, that’s waterproof

Pt Care 2 (6 decks)

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