CCU & ICU Flashcards
Goals and Considerations of PT practice in the CCU/ICU
- High Risk Patients (Medically unstable)
Goals:
* Decrease complication and overall morbitidty
* Restore patient to maximal functional capacity
Prior to starting treatment, what should you do?
Check all sites of lines
What is an Aterial Pressure Line?
- Thin catheter placed into the artery in the forearm
What are the 3 purposes for an arterial line?
- Direct BP measurement (Continuous SBP, DBP, and mean BP - MAP)
- Sampling blood
- Medication delivery
What do you need to consider when working with a patient with an APL?
- Prior to intervention, note the transducers position and waveform and catheter site location
Arterial Pressure Norms
- Systolic: 100-140 mm Hg
- Diastolic: 60-90 mm Hg
- MAP 70-105 mm Hg
What would an normal APL wave be?
What would an overdampened wave look like? What does this mean?
- Transducer is above the heart
OR - Heart is not able to keep up. Pt. will likely have symptoms. If you elevate them and you see this you need to return them to a supine position. May be experiencing hypotension.
What does an underdampened wave mean? What does it look like?
- Transduce is below the heart
What does an underdampened wave mean? What does it look like?
- Transduce is below the heart
What readings would you get if the transducer is above or below the heart level?
- if transducer is below right atrium the pressure readings will be increased
- ~1 inch below = 2 mmHg rise
- if transducer is above right atrium pressure readings will be decreased
- ~1 inch above = 2 mmHg reduction
Arterial Line Complications
- Bleeding
- Infection
- Lack of blood flow to the tissue distal to the incision (due to catheter); Need to look at the color, temp and pulse to ensure good blood flow
What is a central venous pressure?
- Cathether that is inserted (via subclavian, jugular, or femoral) that sits just outside thr right atrium that reads the pressure in the large vein
Normal Range for CVP? What would abnormal possibly indicate?
- 2-8 cm H2O
- Greater than 12 could indicate: HF or Pulmonary artery stenosis
What is the CVP used for?
- High volume administration (large veins)
- Frequent blood draws
- Medications
PT considerations CVP
- ROM can be performed but ensure NOT to occlude the catheter (may happen with arm exercises)
- Ensure the transducer stays at the heart level and that if it needs to be disconnected to ask nursing to do so.
- If entry site is on an arm, NO BP on that arm
What is a Peripherally inserted catheter? What is it used for?
- Catheter inserted in the central or peripheral vein that sits just outside the right atrium
- Used to provide medications (Ex: antibiotics)
PT Considerations - PICC
- Less invasive, lower risks and can be placed for longer period of time
- ROM may be performed, DO NOT OCCLUDE CATHETER
- NO BP on that arm
What is a pulmonary artery catheter? What does it do?
- Catheter that goes through subclavian, jugular or femoral into the pulmonary artery
- Gives information about the R atrial and R ventrciular pressure and pulmonary artery pressure
- Information on preload
- Allows for medications, fluids and venous O2 sat
PT Considerations - PAC
- No ambulation
- Pt may sit at edge of bed or pivot transfer (with nurse present)
- Caution w/ ROM not to occlude catheter
- Towel roll under axilla or neck may aid in preventing line occlusion in side-lying
- Pulmonary HTN: mean pressure greater than 25 mmHg; norm is 10-20 mmHg
- Pulmonary Wedge Pressure (balloon with catheter in pulmonary artery; be careful with tugging)
What is an Intra-aortic balloon pump? What does it do?
Balloon that contracts in diastole to help in increasing the blood to send blood to the coronaries to better feed heart that is recoverying. Typically ported in the femoral artery.
PT considerations - Intra-aortic balloon pump
- Generally no PROM or AROM of LE on involved side (typically bedrest)
General Rules:
* Keep hip flexion less than 70 degrees for transfers
* Keep involved leg straight
* Out of bed activities contraindicated until catheter is removed
* Avoid kinking when rolling
The only way for someone to get more oxygen is by…
changing the partial pressure!
What are chest tubes used for?
Drains blood, fluid and air to allow for full expansion of the lungs
Placed into the pleural space by suturing a tube in between the ribs.
