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CPPT II > COMPS+CLINIC:FINAL: Unit 3: Lines and Tubes in Acute Care > Flashcards

COMPS+CLINIC:FINAL: Unit 3: Lines and Tubes in Acute Care Flashcards

1
Q

Ex’s of NON-invasive monitoring equipment

A
  • EKG/Telemetry/Holter
  • PulseOX
  • BP machine
  • EKG w/ RR
  • Temp monitor
  • Electroencephalogram (EEG)
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2
Q

Cardiac monitoring

Arterial Line

fun fact about this…..

A

Restricts joint mvmt***

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3
Q

Cardiac monitoring

Arterial Line

2 Functions:

A
  1. Continuously measures arteral BP—SBP/DBP (MAP)
  2. Allows access for drawing blood for ABG
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4
Q

cardiac monitoring

Arterial Line

LOCATION

A

Radial aa

Femoral aa

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5
Q

cardiac monitoring

Arterial Line

*talk about Positioning

A

POSITIONING for arterial line transducer is IMPORTANT***

*needs to be moved BEFORE pt if hanging

MUST STAY ABOVE RT. ATRIUM

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6
Q

Arterial Line

Ex. Radial Artery

A

see pics

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7
Q

PRECAUTIONS for Arterial Line

A
  • Transducer for Arterial line shoud be pos’d @ lvl of Rt. Atrium—-> assures accurate pressure values
    • ​Transducer LOW== HIGHER BP
    • Transducer HIGH == LOWER BP
  • **if A-line dislodged—–apply pressure and notify nursing
    • Maintain SLACK on line to prevent dislodge
  • DO NOT let pt FLEX/EXT wrist to prevent aa damage
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8
Q

A-Line Transducer Pos’ing

If too LOW

A

HIGHER BP

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9
Q

A-line Transducer pos’ing

Transducer too HIGH

A

LOWER BP

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10
Q

Cardiac monitoring

Swan-Ganz cath/Pulm aa cath

EASIEST WAY TO RECOGNIZE IT

A

ITS YELLOW****

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11
Q

Swan Ganz cath/Pulm aa cath

Gets ALL PRESSURES of heart EXCEPT….

A

SBP

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12
Q

Swan Ganz cath/Pulm aa cath

Measures hemodynamic status in critically ill cardiac pts

What does this include??

A
  • Pulm Cap Wedge Pressure (PCWP)
    • pts w/ pulm edema OR pulm HTN
  • Left atrial and Ventricular End-diastolic pressures
  • Central venous pressure (CVP)
  • CO
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13
Q

Cardiac Output

HR*SV===

A

amt. of blood pumped by the heart per unit of TIME

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14
Q

Swan Ganz Cath/Pulm aa cath

computes Cardiac Index

what is this?

A

Cardiac Index

  • CO per sq meter of body surf area
  • SHOULD BE 3 OR >
    • ​IF <2.1====Acute heart failure or cardiogenic shock
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15
Q

Swan Ganz cath/ pulm aa cath

allows IV access for what?

A

Medication admin AND obtain mixed venous blood gases

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16
Q

Swan Ganz/Pulm aa cath

Dx if using this:

A

Pulm edema OR Pulm HTN

LV heart failure

RV failure

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17
Q

Swan Ganz Cath/Pulm AA cath

Route/Pic

A

see below

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18
Q

Swan Ganz Cath

Has a balloon…what should you remember about this balloon???

A

NEVER see pt when balloon is Inflated

*Stops blood flow

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19
Q

Swan Ganz Cath and various pressures it reports:

A
  • Balloon inflated== PCWP
  • Prox Port in R. Atrium==CVP
  • PCW==LAP
  • ALL GIVES CO
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20
Q

Possible Complications of the PA Cath (Swan Ganz)

*remember its YELLOW!!!

A
  • Comps of insertion and dislodgement of the PA Cath (swan ganz):
    • ​Malignant arrhythmias
    • Pulm aa rupture
    • Pulm valve tear
    • Infection
  • ****if mobility is essential——need EXP’d clinician only AFTER pt is det’d hemodynamically stable
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21
Q

Green Light

Yellow Light

Red Light

ALL DEFINED

A

see pics

KNOW THIS!!!

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22
Q

Cardiovascular Considerations

Pulm aa cath (swan ganz) OR other continuous cardiac output monitoring devices

In-bed vs. Out-of-bed

A

IN BED====GREEN

OUT-OF-BED===YELLOW (CAUTION

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23
Q

CARDIAC monitoring

Rectal Temp Monitor

A
  • Typ used w/ pts who are:
    • Comatose
    • Intubated
    • HypOthermic
    • Septic w/ HypERthermia

**Goes UP IN rectum

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24
Q

Cardiac monitoring

Trans Venous Pacemaker

A
  • TEMP PM for the heart post-sx
  • @ risk for arrhythmias W/OUT an underlying arrhythmia
  • DO NOT MAKE TAUT
  • goes thru diaphragm
  • SA component vs. AV component—-has BOTH
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25
Q

Transvenous PM

GREEN light vs. YELLOW vs. RED

Dependent rhythm vs. Stable rhythm

A
  • DEPENDENT RHYTHM—-PM does EVERYTHING, pot. to go into arrhythmia
    • IN-BED==YELLOW
    • OUT-OF-BED==RED
  • STABLE RHYTHM
    • ​IN-BED==GREEN
    • OUT-OF-BED==GREEN
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26
Q

CARDIAC MONITORING

Automatic Implantable Cardiac Defribrillator

AICD

A
  • TEMP Defribillator —-> Life Vest
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27
Q

PERMANENT PM’S and

AICD (Automated Implantable Cardiac Defrib.)

Sx placed WHERE

A

UNDER Left Clavicle

*ALWAYS LEFT

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28
Q

INTRA-Aortic Balloon Pump

IABP

A
  • Assists w/
    • Circulation of blood
    • Reduces O2 consumption
  • PT Imps for mobilizing pts on IABP
    • ​Femoral
    • Axilla
  • *CAN ALSO BE A PM
    • ​CA perfusion
    • Pacing
    • SV
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29
Q

Intra Aortic Balloon Pump

IABP

Inflation/Deflation

A

INFLATES during Diastole —-CA perfusion

DEFLATES during Diastole—–pumps blood OUT

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30
Q

Femoral IABP

IN-BED vs. OUT-OF-BED EX’S

A
  • IN-BED====GREEN LIGHT
  • OUT-OF-BED===RED LIGHT
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31
Q

Cardiac monitoring

Ventricular Assistive Device

VAD

A

Augments the pumping capability of the Heart

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32
Q

Ventricular Assistive Device

VAD

2 types:

A
  1. LVAD
    1. ​L.Vent Assistive Device
  2. BiVAD
    1. ​Bilateral Vent Assist Device
  • Dx:
    • ​NON-reversible End-Stage HF
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33
Q

2 Reasons for Receiving VAD

A
  1. Bridge to Transplant
    1. ​NON-reversible L. HF and MUST be candidate for transplant
  2. Destination Therapy Criteria===No hope outside LVAD
    1. NYHA Class 4
    2. Failed optimal med mgmt 40/60 days
      1. ​IABP >7days OR IV Inotropes 14days
  3. LVEF <25%
  4. VO2 <14 OR unable to perform due to IABP, inotropes
34
Q

Ventricular Assistive Device

VAD

PT Imps:

A
  • Keep MAP b/w 60-80 (LOWER end)
    • ​**NORM==80-90
    • MAP–> avg. PRESS in pts arteries during one cardiac cycle
      • ​BEST indicator of perfusion to vital organs
  • Take BP w/ doppler (like ABI)
  • ALL anticoagulation precautions—-bleed risk
    • ​Tx BALANCE ****
35
Q

VAD MACHINE

A
  • **REMEMBER ONLY GETS MAP
    • ​NO systole
    • NO diastole
    • NO pulse
    • BECAUSE NO SYSTOLE***
36
Q

VAD

IN BED vs. OUT-OF-BED EX’S

A
  • IN-BED====GREEN LIGHT
  • OUT-OF-BED===GREEN LIGHT
37
Q

Neurological Monitoring

*Usually looking @ ICP

Ex. SHUNT

A

Before vs. After Shunt

38
Q

What should you ABSOLUTELY REMEMBER about pts w/ INCd ICP???

A

DO NOT LAY THEM DOWN FLAT!!

Flat OR Trendelenberg INCs ICP***

39
Q

Neurological monitoring

ICP monitoring

Dx (who?)

A
  • Pts w/ severe brain injury OR s/p cranial sx
40
Q

Neuro Monitoring

ICP monitor

Values (value of ICP)

A
  • NORMAL: 0-10 (adults)
    • ​KEEP <20mmHg for Mobility
41
Q

Neuro monitoring

ICP monitoring

PT Imps:

A
  • *HOB must be >20degs w/ ICP monitor
  • HOLD activities that can cause an INC in ICP
  • ***REMEMBER
    • ​NEVER LAY THEM FLAT
    • Flat or Trendelenberg INCs ICP****
42
Q

Neuro Monitoring

ICP monitor

Ventriculoperitoneal Shunt/VP Shunt

INTRAVENTRICULAR CATH

AD vs. DISAD

A
  • ADVANTAGES
    • allows for BOTH monitoring and for therapeutic drainage of CSF to reduce ICP
  • DISADVANTAGES
    • Risk for infection bc Invasive
43
Q

Neuro Monitoring

ICP monitoring

Subarachnoid Screw

ICP BOLT

AD vs. DISAD

A
  • ADVANTAGES
    • relatively Easy to install
  • DISADVANTAGE***
    • Accuracy LESS than ventriculostomy drain w/ HIGHER ICP and lack of CSF drainage if needed
44
Q

Neuro monitoring

ICP monitoring

EPIDURAL SENSOR

AD vs. DISAD

A
  • ADVANTAGES
    • LESS invasive: epidural lining is not perforated
  • DISADVANTAGES
    • LACK of CSF drainage if needed
45
Q

ICP Monitoring

Ventriculoperitoneal Shunt

VP shunt

Intraventricular Catheter

Defined :

A

Catheter placed thru a burr hole into the lateral ventricle

46
Q

ICP Monitoring

Subarachnoid Screw

ICP Bolt

A

*Hollow screw inserted thru burr hole drilled into Dura mater (OUTERMOST LAYER)

47
Q

ICP Monitoring

Epidural Sensor

A
  • Sensory device placed thru a burr hole just over the epidural covering
48
Q

VP shunt

49
Q

ICP Monitoring

Active mgmt of intracranial HTN

ICP NOT in Desired Range

IN-Bed vs. OUT-of-Bed

A

IN-BED===RED

OUT-OF-BED===RED

50
Q

ICP MONITORING

ICP Monitoring W/OUT active mgmt of Intracranial HTN

IN-BED vs. OUT-OF-BED

A
  • IN-BED===GREEN (w/ HOB elevated >20degs)
  • OUT-OF-BED===YELLOW (Caution)
51
Q

Pulmonary monitoring

Chest Tubes:

2 Functions

A
  1. Used to remove fluid from pleural OR mediastinal space w/ a hemothorax, pleural effusion, OR pus in pleural space
  2. Provide intrapleural pressure in a pneumothorax
    1. ​CLOSED PRESSURE
      1. GREATER PRECAUTIONS***
52
Q

EX:

Chest Tube for a L. Sided Pneumothorax

***Makes a Closed System

53
Q

Refresher****

Serosanguinous

A

Blood + Edema (fluid)

54
Q

Chest Tube Precautions

Effective Mobilization

A

For Effective Mobilization:

  • ​Ensure pt is premedicated for pain
  • ALWAYS keep chest tube drainage system BELOW chest lvl
  • Check for air leaks
  • ALWAYS discuss w/ Dr or Nurse BEFORE disconnecting suction
  • Portable suction may be used when indicated
  • AFTER chest tube removed—HOLD THERAPY until radiography R/O Pneumothorax
    • _​_see pt BEFORE tube removed
  • NEVER KNOCK OVER THE filter system (usually on floor next to bed)
55
Q

Pulmonary monitoring

Extracorpeal Membranous Oxygenation

ECMO***

A
  • External circulatory assist device that provides direct oxygenation of the blood AND assists w/ removal of CO2
  • **SUSTAINS LIFE**
56
Q

3 Methods of Mechanical Ventilation

A
  1. Nasal pharyngeal tube
  2. Oral ET tube —-short-term
  3. Tracheostomy tube—long-term (3d-3wks)
57
Q

ECMO

IN-bed vs. OUT-of-Bed

A
  • IN-BED===GREEN
  • OUT-OF-BED===YELLOW (CAUTION)
58
Q

RESP CONSIDERATIONS

Intubation

  • ET Tube
  • Tracheostomy Tube

IN-bed vs. Out-of-Bed

A
  • BOTH IN-BED and OUT-OF-BED===GREEN
59
Q

Vascular Monitoring

CENTRAL LINE

Triple Lumen Cath

“Triple” why?

A

Jugular

Subclavian

Femoral

60
Q

CENTRAL LINE

Triple Lumen Catheter

61
Q

Delayed Risks Assoc’d w/ Central Venous Access

A
  • Infection
  • Cath fx
  • Cath dislodge
  • Cath occlusion
  • Air in Cath
62
Q

Renal monitoring

Hemodialysis

How OFTEN ?

A

@ LEAST 3x/week

63
Q

Renal monitoring

Hemodialysis

A

Replaces function of Kidneys

64
Q

Renal monitoring

Hemodialysis

2 entry options:

A
  1. Arteriovenous fistula
    1. ​*AVOID using arm when measuring BP
  2. Hemodialysis catheters—> Permacath
65
Q

Hemodialysis

2 Types:

A
  • HD–3x/week
  • CVVHD–more stable bc constant
66
Q

HD

Hemodialysis

A
  • 3x/week if end-stage kidney failure
  • 2hr pd of time
  • 5-8L fluid removed in 2hrs
    • ​Pts WILL BE EXHAUSTED!!!
67
Q

CVVHD

Continuous

*ONLY ICU—> Critically ill and cannot tolerate dialysis

IN-BED vs. OUT-OF-BED

A

*NOTE: TAKE BP FREQ’LY*

  • IN-BED====GREEN
  • OUT-OF-BED===GREEN
68
Q

What should you ABSOLUTELY REMEMBER about NG tube feeding?

A

NO LYING FLAT W/IN 30MINS OF NG TUBE FEEDING***

69
Q

GI Monitoring

SHORT-TERM

NG Tube

Nasogastric

A
  • Tube: nostril–> stomach
  • oral meds and temp feeding
  • short-term gastric suctioning
  • EX: Dubhoff tube
  • mouth taped off
70
Q

GI monitoring

SHORT-TERM

IV Fluids or Feedings

“Tube Feedings”

71
Q

GI Monitoring

LONG-TERM

All PERMANENT—Sx implanted

3 types

A
  1. Gastrostomy Tube (GT Tube)
  2. Percutaneous Endoscopic Gastrostomy Tube (PEG Tube)
  3. Jejunostomy Tube (J Tube)
72
Q

Rectal Monitoring

SHORT-TERM

Rectal Tube

A

smells

Not fully secure

73
Q

Rectal monitoring

LONG-TERM

Ostomy Bag

A

LONG TERM Rectal monitoring

74
Q

Urinary Monitoring

4:

A
  1. Foley
  2. Supra-pubic
  3. Texas (condom) Cath
  4. **Nephrostomy Tube (NEW)
75
Q

Urinary monitoring

Nephrostomy Tube

A
  • RIGHT BEFORE Loop of Henle
    • ​renal aa into kidneys
      • ​takes OUT fluids
76
Q

Integumentary Invasive Monitoring Equipment

77
Q

ALL OTHER DRAINS AND TUBES

IN-BED vs. OUT-OF-BED

A

NG

Central Venous Cath

Pleural Drain

Wound Drain

Intercostal Cath

Urinary Cath

IN-BED and OUT-OF-BED===GREEN

78
Q

EQUIPMENT FOR DVT PREVENTION

2:

A
  1. Sequential Compression Device (SCD Stockings)
    1. ​Intermittent compression
      1. ​Timed squeezes
  2. TEDs
79
Q

What can go on SUCTION

suction attached to wall

OR chest tube tower

A
    1. NG tube to suction
      * ​bile/poop
    1. Chest tube to suction
      * ​ALL PNEUMOTHORAX MUST BE ON SUCTION***
    1. ET Tube or Tracheostomy w/ suction

CPPT II (6 decks)

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