Chapter 14 Flashcards
1
Q
What is NG Tube?
A
Nasogastric Tube
plastic or rubber tubes
Inserted through the nasopharynx into the stomach
2
Q
NG Tube is used for
A
Administration of medications Gastric decompression (most common) Removal of gas (flatus) & fluids from stomach after intestinal obstruction or major trauma
3
Q
5 types of NG tube are
A
Levin (common) Sump (common) Nutriflex Moss Sengstaken-Blackemore (S-B)
4
Q
Levin tube
A
Most common
1 lumen
Plastic
Passed through nose into stmach
5
Q
Levin tube used for
A
Gastric decompression
6
Q
Sump tube also called
A
Salem-sump tube
Most common
7
Q
Sump tube is
A
Double-lumen Blue extension (* pig-tail) is the 2nd lumen Lets air flow into stomach
8
Q
Nutriflex tube
A
1 lumen
mercury-weight tip
feeding
9
Q
Moss tube
A
3 lumen-complex
Balloon to anchor into stomach
2nd & 3rd lumen used for aspiration & feeding
10
Q
Sengstaken-Blackemore tube
S-B
A
3 lumens
thick catheter
2 balloon
control bleeding from esophagus
11
Q
Nasogastric Tube Equipment
A
NG tube Water-soluble lubricant 20 to 50 ml syringe Tetracaine Contrast (under fluoro in correct place) Tissue Tape Emesis basin Gloves Towels Glass of water with straw Saline (flush it)
12
Q
Nasoenteric Tube (NE Tube)
A
Same material as NG tubes
Inserted same as an NG
Passes into duodenum & small intestines by peristalsis
Weighted metal tip (single)
13
Q
NE Tube used for
A
Decompression
Diagnosis
Treatment
14
Q
3 types of NE tube
A
Cantor
Harris
Miller-Abbott
15
Q
Entriflex / Dobhoff tube
A
Single narrow lumen tube with removable wire stylet Placed into duodenum or jejunum Not used with suction Thinner & more flexible than NG tubes Leave in for long periods of time
16
Q
Gastrostomy Tube
A
A surgical creation of an opening into the stomach from where a tube is placed from inside the stomach to the external abdominal wall
17
Q
Gastrostomy Tube Used for
A
Feeds a patient who cannot tolerate the intake of oral food
Temporary or permanent
18
Q
Most common type of Gastrostomy Tube is
A
PEG tube (percutaneous endoscopic gastrostomy) Placed during endoscopy or surgery
19
Q
Central Venous Lines also called
A
central venous catheters or venous access devices
Also named for developer – Hickman or Groshong
20
Q
Central Venous Lines
A
Wide variety of clinical application Administer a variety of drugs Manage fluid volume Serve as a conduit for blood analysis & transfusions Monitor cardiac pressure
21
Q
Central Venous Lines mainly used for
A
chemotheraphy & parenteral nutrition
May be single-, double-, or multi-lumen
22
Q
Most common insertion site of Central Venous Lines is
A
Subclavian vein
Can also use internal jugular & femoral veins
23
Q
Position of Central Venous Lines should be
A
Superior vena cava – approximately 2 to 3 cm above opening of right atrium
24
Q
Pulmonary Arterial (PA) Catheter also called
A
Swan-Ganz catheters
25
Pulmonary Arterial (PA) Catheter
Single- or multi- lumen CV lines
Incorporates a small electrode @ distal end, used to monitor arterial pressure
Distal tip will be in one of the two pulmonary arteries
Enters through the right internal jugular & ends in right PA
26
Peripherally inserted central catheter (PICC)
Inserted by a nurse/radiologist/or specially trained radiographer
Inserted into the patient’s arm and advanced until its tip lies in a central vein (best side of pt)
27
Implanted Access Port
Port-A-Cath, Infusa Port, Mediport (lung)(pt w/port not have a good vein)
28
Implanted Access Port used for
Patients with long term illnesses requiring frequent IV medications or transfusions
29
Implanted Access Port made of
plastic, titanium or stainless steel
30
Implanted Access Port Implanted into
the subcutaneous tissue of the chest
Not visible but can be palpated
Catheter from the port is inserted into the subclavian or internal jugular vein
Utilizes a huber needle
31
Emergency Suctioning indication
Profuse vomiting in a patient who can not voluntarily change their position
Audible rattling or gurgling sounds coming from patient’s throat
Signs of respiratory distress
32
Emergency Suctioning purpose
To prevent aspiration or respiratory arrest
| It is not within our practice to perform suctioning.
33
Contraindications for Suctioning
```
Head or facial injuries
Bleeding esophageal varices
Nasal deformities
Trauma
Cerebral aneurysms
Tight wheezing, bronchospasm or croup
```
34
Suctioning Equipment
```
Wall outlet or working portable suction machine
Sterile gloves
Tubing
Disposable suction set with various catheter sizes
10 F to 18 F Adults
5 F to 8 F Children
Sterile container for solution
Sterile water or sterile normal saline
Oxygen
Gown, mask and goggles
```
35
Tracheostomy
An opening into the trachea that is created surgically to provide a temporary/permanent artificial airway to a patient
Provides an airway during upper airway obstruction
36
Tracheostomy Tube Indications
Traumatic injury
Paralyzed
Unconscious or suffering from disease which has affected respiration
37
Tracheostomy Tube Precautions
```
Metal or plastic design
Cuff
Helps to seal the tracheostomy to prevent air leaks or aspiration
Ties to hold in place
Do not untie and do not remove the tube
Patients are suctioned
Explain procedure to patient
```
38
Mechanical Ventilator
Artificial airway connected to a mechanical ventilator
Patients are not able to breath spontaneously
Endotracheal tube or tracheostomy tube
39
Ventilator delivers
a minimum set respiratory rate, preset inspiratory volume, and consistent FiO2
Radiographs may be taken to confirm correct placement
40
Manual ventilation
Use an Ambu bag (blue color)
A device that is squeezed regularly by hand to force respirations
Used during transportation and when setting up ventilation
41
Clinical term used is for Ambu bag is
“bagging patient”
42
Endotracheal Tubes
Tube inserted through the mouth into the trachea with correct placement of tip 5 to 7 cm above the tracheal bifurcation
43
Endotracheal Tubes Indications for use
Need mechanical ventilation or oxygen delivery due to inadequate breathing
Inadequate arterial oxygenation
Parenchymal diseases that impair gas exchange
Upper-airway obstruction
Impending gastric acid reflux or aspiration
44
Endotracheal Tubes: Radiographs needed for placement and thereafter
20% require repositioning of tube
Malpositioning into right main-stem bronchus which causes overventilation of right lung & possible airway obstruction to left (atelectasis)
45
Thoracostomy Tubes also called
CHEST TUBE
46
Thoracostomy Tubes USES FOR
```
Drain intrapleural space & mediastinum
Fluid or air accumulate
Creates a negative pressure
Fluid or air accumulate causing pressure to be lost and the lungs fail to expand fully
If too low a pressure, lungs collapse
```
47
Thoracostomy Tubes Condition
Pneumothorax (air)
Hemothorax (blood)
Pleural effusion (fluid)
Empyema (infective)
48
Thoracostomy Tubes insertion site vary
with the intrapleural substances to be removed (pt can have more than 1 chest tube)
49
Fluids (hemothorax or pleural effusion):
usually inserted in 5th to 6th intercostal space
| Can be as high as 4th intercostal space and as low as 8th
50
Air (pneumothorax):
requires a higher insertion because air rises
| 2nd to 3rd intercostal space @ midclavicular line
51
Tissue Drains
Placed at or near a wound site or operative site
| One end of the tube or drain is placed in or near the operative site, and the other end exits the body wall
52
3 common postoperative drains
Hemovac
Jackson-Pratt
Penrose
53
Penrose drain
Soft rubber tube
Sterile safety pin keeps tube from slipping into surgical wound
Drains into a surgical dressing
54
Jackson-Pratt and Hemovac drains
Plastic drainage tube
Maintains a constant low negative pressure
Drainage goes from tubing into bulb
Used for hip surgeries
55
Urinary Catheters
```
Indwelling catheter (catheter that remains inplace)
Insertion of a tube into the bladder using aseptic technique
```
56
Two main types of Urinary Catheters
```
Retention balloon (Foley) (B)
Straight type (A)
```
57
How to Use French system for sizing
8 F to 18F (outer diameter of catheter)
| Choose larger size when possible
58
Balloon is filled with
Balloon is filled with sterile water to hold catheter in place after insertion
59
Drainage bag must be
kept lower than patient’s bladder @ all times to prevent retrograde flow into bladder
Failure to do so can lead to infection
Bags should never drag on floor
60
When transferring patients by wheelchair or stretcher
Ensure that the drainage bag & tubing do not become entangled in wheels or caught on passing objects.
61
Urinary Catheter purposes
```
Bladder emptying
Relieve bladder retention
Irrigate bladder
Introduce drugs into bladder
Permit accurate measurement of urine output
Relieve incontinence
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