Control Comp #1 (Assisting w/Intubation, Adult Endotracheal Tube Care (Securing Airway, Cuff MNGT), Adult Inline Suctioning, Arterial Lines ABG's)

Question 1

Ventilatory Support - Assist with Intubation (1)
Procedure Steps (17 Steps)

Answer 1

Procedure Steps
1. Verifies physician’s orders
2. Scans chart for any other pertinent data and notes, including diagnosis, medications, therapies, radiographic and other laboratory results
3. Gathers, assembles equipment, washes / gels hands, applies appropriate PPE*
4. Identifies and positions patient, hyperinflates & oxygenates the patient via BVM
5. Prepares the laryngoscope handle and blade
6. Prepares suction with yankauer
7. Checks ETT cuff and lubricates ETT after assuring cuff is safe, inserts stylette
8. Hands ETT or suction to person intubating when asked
9. Once ETT is in place, removes stylette, inflates cuff
10. Provides ventilation with BVM with C02 connect attached following intubation
11. Performs 5-point auscultation for ETT position
12. Stabilizes tube with tape, tube holder, or twill
13. Assures that a CXR is ordered
14. Places patient on ventilator
15. Correctly care for equipment following the procedure
16. Cleans up area and washes / gel hands
17. Document appropriately

Question 2

Ventilatory Support - Assist with Intubation
Procedure Steps (Steps 1-4)

Answer 2

Procedure Steps
1. Verifies physician’s orders
2. Scans chart for any other pertinent data and notes, including diagnosis, medications, therapies, radiographic and other laboratory results
3. Gathers, assembles equipment, washes / gels hands, applies appropriate PPE*
4. Identifies and positions patient, hyperinflates & oxygenates the patient via BVM

Question 3

Ventilatory Support - Assist with Intubation
Procedure Steps (Steps 5-14)

Answer 3

5. Prepares the laryngoscope handle and blade
6. Prepares suction with yankauer
7. Checks ETT cuff and lubricates ETT after assuring cuff is safe, inserts stylette
8. Hands ETT or suction to person intubating when asked
9. Once ETT is in place, removes stylette, inflates cuff
10. Provides ventilation with BVM with C02 connect attached following intubation
11. Performs 5-point auscultation for ETT position
12. Stabilizes tube with tape, tube holder, or twill
13. Assures that a CXR is ordered
14. Places patient on ventilator

Question 4

Ventilatory Support - Assist with Intubation
Procedure Steps (Steps 15-17)

Answer 4

15. Correctly care for equipment following the procedure
16. Cleans up area and washes / gel hands
17. Document appropriately

Question 5

Adult In-line Suctioning (Vent) (2)
Procedure Steps (17 Steps)

Answer 5

Procedure Steps
1. Verifies facility protocol*
2. Gathers equipment
3. Utilizes and maintains standard precaution as required
4. Identifies patient, introduces self and department*
5. Explains purpose of the procedure
6. Assesses patient before beginning therapy*
7. Places patient in proper position
8. Assures that the proper level of vacuum is provided
9. Provides 100% oxygen and hyperinflates prior to suctioning
10. Performs steps in accordance with facility protocol
11. Confirms tip of the catheter is not occluding the airway
12. Assesses patient for any adverse effects and is well oxygenated t/o procedure
13. Reassesses patient after procedure
14. Cleans up area
15. Thanks patient, assures patient’s safety and needs
16. Disposes of PPE; Washes / gels hands*
17. Documents

Question 6

Adult In-line Suctioning (Vent)
Procedure Steps (Steps 1-7)

Answer 6

Procedure Steps
1. Verifies facility protocol*
2. Gathers equipment
3. Utilizes and maintains standard precaution as required
4. Identifies patient, introduces self and department*
5. Explains purpose of the procedure
6. Assesses patient before beginning therapy*
7. Places patient in proper position

Question 7

Adult In-line Suctioning (Vent)
Procedure Steps (Steps 8-12)

Answer 7

8. Assures that the proper level of vacuum is provided
9. Provides 100% oxygen and hyperinflates prior to suctioning
10. Performs steps in accordance with facility protocol
11. Confirms tip of the catheter is not occluding the airway
12. Assesses patient for any adverse effects and is well oxygenated t/o procedure

Question 8

Adult In-line Suctioning (Vent)
Procedure Steps (Steps 12-17)

Answer 8

13. Reassesses patient after procedure
14. Cleans up area
15. Thanks patient, assures patient’s safety and needs
16. Disposes of PPE; Washes / gels hands*
17. Documents

Question 9

Airway Management - Endotracheal Tube Care (3)
Procedure Steps (22 Steps)

Answer 9

Procedure Steps
1. Gathers appropriate equipment.
2. Checks physician’s orders, checks placement in chart.
3. Identifies patient, self and department.
4. Washes hands / gloves, checks placement on flow sheet.
5. Explains procedure / confirms patient understanding.
6. Positions patient for accessibility and comfort.
7. Assess patient (HR, RR, BS, BP, SpO2).
8. Checks current tube placement noting markings relative to teeth or gum.
9. Prepares tape or tube security system.
10. Suctions patient orally and via endotracheal tube. Ask helper to wash hands and glove.
11. Removes tape or ties and holds tube securely. Use oral suction as necessary.
12. Assesses for skin breakdown, allows shaving and skincare to be provided while holding device is off.
13. Using tongue blade repositions tube to opposite side of mouth.
14. Re-check tube placement by markings and auscultation.
15. Replace tape or security system, checking placement each time tape is placed onto tube assuring one hand is on the ETT AT ALL TIMES
16. Attaches the manometer/syringe to the pilot balloon and listens to the neck for a leak. Adjust cuff pressure/volume if a leak is evident. Perform oral care per hospital policy. re-assesses.
17. Disconnects the manometer/syringe from the pilot balloon.
18. Re-assesses patient vital signs, breath sounds, and Vt on Ventilator.
19. Assures patient comfort and safety.
20. Thanks patient. removes gloves and washes hands.
21. Records appropriate information on chart and departmental records.
22. Communicates with appropriate staff.

Question 10

Airway Management - Endotracheal Tube Care
Procedure Steps (Steps 1-7)

Answer 10

Procedure Steps
1. Gathers appropriate equipment.
2. Checks physician’s orders, checks placement in chart.
3. Identifies patient, self and department.
4. Washes hands / gloves, checks placement on flow sheet.
5. Explains procedure / confirms patient understanding.
6. Positions patient for accessibility and comfort.
7. Assess patient (HR, RR, BS, BP, SpO2).

Question 11

Airway Management - Endotracheal Tube Care
Procedure Steps (Steps 8-17)

Answer 11

8. Checks current tube placement noting markings relative to teeth or gum.
9. Prepares tape or tube security system.
10. Suctions patient orally and via endotracheal tube. Ask helper to wash hands and glove.
11. Removes tape or ties and holds tube securely. Use oral suction as necessary.
12. Assesses for skin breakdown, allows shaving and skincare to be provided while holding device is off.
13. Using tongue blade repositions tube to opposite side of mouth.
14. Re-check tube placement by markings and auscultation.
15. Replace tape or security system, checking placement each time tape is placed onto tube assuring one hand is on the ETT AT ALL TIMES
16. Attaches the manometer/syringe to the pilot balloon and listens to the neck for a leak. Adjust cuff pressure/volume if a leak is evident. Perform oral care per hospital policy. re-assesses.
17. Disconnects the manometer/syringe from the pilot balloon.

Question 12

Airway Management - Endotracheal Tube Care
Procedure Steps (Steps 18-22)

Answer 12

18. Re-assesses patient vital signs, breath sounds, and Vt on Ventilator.
19. Assures patient comfort and safety.
20. Thanks patient. removes gloves and washes hands.
21. Records appropriate information on chart and departmental records.
22. Communicates with appropriate staff.

Question 13

VAMP ALine (4)
Procedure Steps (15 Steps)

Answer 13

Procedure Steps
1. Verifies physician’s order and scans chart for any other pertinent data *
2. Gathers equipment, washes / gels hands and applies appropriate PPE*
3. Identifies patient, introduces self and department*
4. Explains purpose of the procedure and assesses patient*
5. Places patient in proper position and locates arterial line; assesses B/P and waveform on monitor
6. Silences the alarm, slowly draw the reservoir up, and close the shutoff valve (perpendicular to the tubing)
7. Clean the needless sampling site with alcohol, attach the needless cannula to a luer-tip syringe, then push the needless cannula into the sample site
8. Draw the appropriate amount for ABG sample
9. Cares for the ABG sample appropriately
10. Open the shutoff valve (parallel to the line), then push the reservoir plunger back down until all fluid is back in the line
11. Flush the line with the flushing device until the line is clear of blood and clean the sampling site with alcohol
12. Assures that B / P and waveform is present on the monitor before leaving the room
13. Reassesses patient before leaving room and cleans up area
14. Transport sample appropriately and / or analyzes with Point of Care Testing
15. Disposes of PPE, washes / gels hands, and documents appropriately

Question 14

VAMP ALine
Procedure Steps (Steps 1-5)

Answer 14

Procedure Steps
1. Verifies physician’s order and scans chart for any other pertinent data *
2. Gathers equipment, washes / gels hands and applies appropriate PPE*
3. Identifies patient, introduces self and department*
4. Explains purpose of the procedure and assesses patient*
5. Places patient in proper position and locates arterial line; assesses B/P and waveform on monitor

Question 15

VAMP ALine
Procedure Steps (Steps 6-12)

Answer 15

6. Silences the alarm, slowly draw the reservoir up, and close the shutoff valve (perpendicular to the tubing)
7. Clean the needless sampling site with alcohol, attach the needless cannula to a luer-tip syringe, then push the needless cannula into the sample site
8. Draw the appropriate amount for ABG sample
9. Cares for the ABG sample appropriately
10. Open the shutoff valve (parallel to the line), then push the reservoir plunger back down until all fluid is back in the line
11. Flush the line with the flushing device until the line is clear of blood and clean the sampling site with alcohol
12. Assures that B / P and waveform is present on the monitor before leaving the room

Question 16

VAMP ALine
Procedure Steps (Steps 13-15)

Answer 16

13. Reassesses patient before leaving room and cleans up area
14. Transport sample appropriately and / or analyzes with Point of Care Testing
15. Disposes of PPE, washes / gels hands, and documents appropriately

Question 17

3 Way Stop Cock ALINE (5)
Procedure Steps (14 Steps)

Answer 17

Procedure Steps
1. Verifies physician’s order and scans chart for any other pertinent data *
2. Gathers equipment, washes / gels hands and applies appropriate PPE*
3. Identifies patient, introduces self and department*
4. Explains purpose of the procedure and assesses patient*
5. Places patient in proper position and locates arterial line; assesses B/P and waveform on monitor
6. Silences the alarm, close the shutoff valve to the reservoir bag, draw a waste sample
7. Draw the appropriate amount for ABG sample
8. Cares for the ABG sample appropriately
9. Close the shutoff valve to the patient, draw a waste syringe to clear out the stopcock
10. Flush the line with the flushing device until the line is clear of blood and clean the sampling site with alcohol
11. Open shut off valve to the patient and assures that B/P and waveform are present on the monitor before leaving the room
12. Reassesses patient before leaving room and cleans up area
13. Transport sample appropriately and / or analyzes with Point of Care Testing
14. Disposes of PPE, washes / gels hands, and documents appropriately

Question 18

3 Way Stop Cock ALINE
Procedure Steps (Steps 1-5)

Answer 18

Procedure Steps
1. Verifies physician’s order and scans chart for any other pertinent data *
2. Gathers equipment, washes / gels hands and applies appropriate PPE*
3. Identifies patient, introduces self and department*
4. Explains purpose of the procedure and assesses patient*
5. Places patient in proper position and locates arterial line; assesses B/P and waveform on monitor

Question 19

3 Way Stop Cock ALINE
Procedure Steps (Steps 6-11)

Answer 19

6. Silences the alarm, close the shutoff valve to the reservoir bag, draw a waste sample
7. Draw the appropriate amount for ABG sample
8. Cares for the ABG sample appropriately
9. Close the shutoff valve to the patient, draw a waste syringe to clear out the stopcock
10. Flush the line with the flushing device until the line is clear of blood and clean the sampling site with alcohol
11. Open shut off valve to the patient and assures that B/P and waveform are present on the monitor before leaving the room

Question 20

3 Way Stop Cock ALINE
Procedure Steps (Steps 12-14)

Answer 20

12. Reassesses patient before leaving room and cleans up area
13. Transport sample appropriately and / or analyzes with Point of Care Testing
14. Disposes of PPE, washes / gels hands, and documents appropriately