Lab Skills Flashcards
IVPB
Supplies:
1. IVPD med
2. Secondary Tubing
3. MAR
4. Tape
5. Alcohol
6. Gloves
(Intact/unopened/unexpired/sterile)
- Preform medication checks before entering the room. Two checks and 5 rights. Ensure compatibility
- Wash hands - Idenitfy - LOC - Allergies
- IV fluid check and IV site
- Complete your last medication check
- Attach and prime the secondary tubing. Making sure to keep sterile and scrubbing the hub
- Infuse the medication
- Document - Wash hands - Record
Intermittent Catheter
Supplies:
1. Intermittent Cath Kit
2. Items for peri care
- Provide the proper peri care for the patient.
- Frog leg the patient and place sterile kit between legs.
- Open sterile kit and set up field. Apply sterile gloves and drape
- Female: Use non dominant hand to spread labia and visualize urethral meatus. Clean meatus using forceps and betadine cotton balls. Clean each side from top to bottom
- Male: Use non dominant hand to grasp penis just below glad holding firmly at 90%. Clean using betadine cotton balls or swabs
- Pick up catheter no more than 2 inches from tip. Ensure it is lubricated. Inset catheter while patient takes deep breath. Insert 1-2 inches after urine begin to flow.
- To collect specimen. Pinch catheter with non dominant hand. Do not remove hand, placing catheter into specimen cup. Release pinch but do not let go. Allow urine to flow into specimen cup.
- When bladder is empty pinch and remove catheter. Preform peri care
Foley Cath
Supplies:
1. Catheter Kit
2. Stat lock
3. Items for perineal care
I should know this one
Trach Suctioning
Supplies:
1. Trach suction kit
2. Stethoscope
3. NS
4. Face shield, mask, googles, gown
5. Pulse oximeter
- Assess for signs and symptoms indicating need for suctioning prior to trach care
- Position patient in semi-fowlers / fowlers position. Hyper oxygenate with 100% O2 set at 10-15L/min and set humidification at 100% for at least 30 seconds. Have patient deep breath 3 x 4 times. Unsnap trach collar ties and lay over trach for easy removal
- Prepare suction device. Turn wall suction on. Set to 80-120 mm/Hg suction. Remove yankauer and place tubing within reach
- Apply need PPE and Open bottle of NS and invert cap on bedside table
- Establish sterile field. Open kit and pop up box. Pour NS into box and replace cap
- Prepare to suction. Apply sterile gloves. Coil trach suction catheter in dominant hand. Pick up tubing with non dominant hand. Attach suction with dominant hand. Using dominant hand place catheter tip into NS. Check functioning by placing non dominant thumb over port and suctioning small amount.
- Preform suctioning: Let patient know. Insert catheter into trach with thumb port open. Do not touch outside of inner cannula. Advance until resistance is met. Pull back 1 cm
- Encourage patient to cough while removing catheter in 1 movement to minimize trauma to mucosa. Use twisting motion and intermittent the suction. Remove within 10 seconds
- Assess patients status between suction passes. Rate effort, O2 sat. Repeat steps 2-3 times allowing 1 min between passess.
- Return O2 flow rate and humidifier to prescribe setting.
NGT
Supplies:
1. Nasogastric tube
2. Sethoscope
3. Water soluble lube
4. 60 mL or larger syinge
5. Hypoallergenic tape
6. pH indicator
7. Glass of water
8. Emesis basin
9. Towel
10. Tissues
11. Clean gloves
12. Suction equipment
13. Penlight and tongue blade
14. Pulse oximeter
- Assess patency of nares and review history of nare. Ask patient to clean each nostril. Preform abdominal assessment. Ask poop questions. Preform respiratory assessment. Apply pulse oximeter
- Assist to high fowler position. Cut tape and have ready. Measure length of tube from tip of nose to lobe to xiphoid process
- Lub the distal end of tube with water soluble lube. Alert pt that insertion will begin. Gently insert tube along floor of nostril to back of throat. Aiming back and down towards ear. Have pt flex head forward after the tube has passed the nasopharynx. Encourage patient to swallow by offering small sip of water and advance tupe as pt swallows. Advance 2.5 - 5 cm each time the pt swallows until length is reached. Secure to bridge of nose
- If resistance is met or pt starts to gag, choke, or become cyanotic stop and pull tube back to oropharynx
- Check placement using penlight and tongue blade. Aspirate gastric contents check pH. < 5.5
- In doudle lumen NG tube: Turn on suction to verify maximal suction is set to low intermittent suction. Insert a anti-reflux device. Maintain pig tail above midline at all times. Never clamp pig tail
- Attach tubing to pt gown with tape. Administer oral and nasal care q 2-4 hrs.
IV push
Supplies:
1. Medication
2. Alc preps and clean gloves
3. Syringes and needles
4. Vial of NS or approved diluent
5. NS flushes
6. MAR
7. Watch for ability to count
- Preform Medication and NS checks.
- Calculate dosages and preform 2 med math checks
- Prepare Saline diluent without contamination maintaining principles of sterility.
- Prepare medication with out contamination maintaining principles of sterility
- Clean - Draw - No Re-cap - Verify - Label (2x)
- Enter patients room. Normal routine
- Perform 3 med check
8:
1. Assess
2. Pause
3. Clean
4. No air
5. Clamp
6. Apirate
7. Flush
8. Clean
9. Med time
10. clean
11. Flush time
12. Clean
13. unclamp
14. Restart
15. Wash
Central line
Supplies:
1. Dressing change kit (Sterile supplies)
2. Chloraprep
3. Antimicrobial path
4. Maks for everyone
5. Injection access cap
6. Stat lock
7. Clean gloves
- Assess for erythema, exudate, and catheter migration. Measure
- Unfold and lay sterile drape. Drop item into drape
- Disinfect catheter skin junction using chloraprep
- apply antimicrobial path. Blue/yellow up
- Secure PICC line with STAT lock
- Apply chlorhexidine impregnated/transparent dressing over site. Tegaderm. Form occlusive seal by pinching the adhesive against the catheter lumen. Do not tent.
If catheter has migrated in or out >3cm, notify the Vascular access Nurse or HCP for confirmation of the location of the tip of the catheter
IV Start
Supplies:
1. Right size IV catheter
2. IV start kit
3. Chloraprep
4. One saline lock with extension tubing
5. 1 prefilled NS syringe
6. Clean gloves and chux
7. Alcohol preps and swabs
- Apply tourniquet 4-6 inches about puncture site. Check distal pulse to confirm arterial flow. Find the correct vien
- Prepare the equipment and maintain sterility. No air bubbles
- Apply clean gloves and clean site with chloraprep
- Re-apply tourniquet above venipuncture site and check pulse
- Insert the catheter using non-dominat hand to stabilize vein 2-3 inches below site. Hold needle at 10-30 degree with bevel up. Watch for flashback. Lower catheter then advance 1/8th inch. Withdrawal needle and release tourniquet.
- Attach saline lock adaptor with NS flush attached and aspirate with syringe to obtain blood flow. Flush. Note any infiltration.
- Secure catheter with tape and tegaderm and label
Trach Care
Supplies:
1. Trach care kit
2. NS and hydrogen peroxide
3. PPE
4. Pluse oximetry
- Prepare sterile field. Open sterile kit and set up sterile field on bedside table. DON sterile gloves. Pour solutions in each compartment
- With non dominant hand: Remove trach dressing and discard. Remove track collar. Remove inner cannula and place in 1/2 and 1/2 solution. Replace trach collar
- Clean inner cannula: Grasp the outer portion. Brush. Rinse. Tap. Hold to eye level. Repeat if needed. Reinsert clean inner cannula without contaminating it and secure.
- Clean face plate and around stoma. Use sterile cotton - tipped applicators moistened with NS to clean under faceplate. Clean faceplate using 4x4 moistened.
- Change securement device if necessary. And secure into place
- Place clean trach dressing under face plate.
- Replace trach collar. Position patient comfortably and assess respiratory status
SBAR
Situation - Background - Assessment -Recommendation
Situation
-Your name and unit
-Patient name/Room number/Patient admit date
-Current problem. When did it begin and
Background
-Pertinent past medical history
-Pertinent background data
-Allergies
-Medications
-Vital signs
-Related body system and labs
-Trending of any unexpected data
-What you have tried
Assessment
-What do you think is happening. What body system do you think is involved. Your interpretation of the data
Recommendation
-What do you need the provider to to do to improve the patients situation
-Offer solutions
Assessing for respitroy distress
- Increase in agitation / restlessness
- Increase in BP/HR/RR and decrease O2
- Increasing in noisy congestion when trying to cough
- Course breath sounds
