Lines and Tubes Flashcards
Purpose & placement of nasogastric tube (NG tube)
- to provide feedings for patients who are unsafe to swallow food
- keeps the stomach empty after surgery & rests the bowel
- placed in the nose or mouth to the stomach
Indications for a nasogastric tube
- enteral feeding &/or gastric drainage
- decompression of the stomach
- patients experiencing dysphagia
Clinical implications for nasogastric tube
- check orders to see if it can be disconnected; have a nurse disconnect
- avoid lying the patient flat while feeding to avoid asphyxiation
- watch cognitively impaired patients very closely as the tendency is to pull at tubing
Purpose & placement of nasal cannula
- delivers supplemental oxygen up to 6L/min
- fraction of inspired Oxygen (FiO2) designed for 24-44%
- placed in the nose
Indications for a nasal cannula
- patients who require increased O2 levels either at rest or with activity
- patients who are unable to maintain Oxygen saturation on room air alone
Clinical implications for a nasal cannula
- use portable oxygen tank for mobility outside of the room
- monitor oxygen saturation throughout session
- it is appropriate for therapists to titrate oxygen levels in order to assist patient in maintaining physician ordered oxygen saturation levels. Orders must be obtained from MD before changing titration levels
Purpose & placement of a closed face mask
- form of supplemental oxygen mixed with room air
- allows for collection of O2 around nose and mouth
- fraction of inspired Oxygen (FiO2) designed for 40-60%
- placed over the patient’s mouth and nose by patient, therapist, or other personnel
Indications for a closed face mask
- oxygen delivery at rest or during activity
- patients who are unable to maintain adequate Oxygen saturation with room air alone
Clinical implications for a closed face mask
- use portable O2 tank for mobility outside of the room
- monitor oxygen saturation throughout session
- it is ok for physical therapists to titrate oxygen levels in order to assist patient in maintaining physician ordered oxygen saturation levels. Obtain physician orders before increasing oxygen concentration
Purpose & placement for a tracheostomy collar
- provide supplemental humidified oxygen or air
- placed by a Medical Doctor in the trachea through an opening made in the neck called a stoma
Indications for a tracheostomy collar
- mechanical ventilation or prolonged ventilatory support
- after a laryngectomy, tracheal resection, or other head and neck surgeries
Clinical implications for a tracheostomy collar
- if the tracheostomy collar is not capped, the patient will be unable to talk
- coordinate therapy session dependent on respiratory needs
- when patient coughs, fluids may escape from stoma if it is not capped
Purpose & placement for a ventilator
- provides maximum breathing support
- patient may be connected via tracheostomy tube or a less permanent endotracheal tube (ETT)
- connected during surgery by a Medical Doctor
Indications for a ventilator
- replaces breathing during or after surgery to facilitate rest to the heart
- respiratory failure
Clinical implications for a ventilator
- coordinate with nursing and respiratory therapists to determine appropriate level of activity
- if patient can tolerate out of room activities, consider the use of a portable ventilator
- patient will be unable to speak with the ventilator attached
- patient may tire more easily when weaning from ventilation
Purpose & placement for a ventriculostomy
- assists with and monitors intracranial pressure drainage
- placed by a Medical Doctor in the anterior horn of the lateral ventricle via a burr hole
Indications for a ventriculostomy
- drainage or sampling of cerebrospinal fluid (CSF)
- monitoring of intracranial pressure (ICP) post trauma
Clinical implications for a ventriculostomy
- head of bed should be elevated 30 degrees when unclamped
- prior to moving the patient, the drainage tube should be clamped; check with nursing and physician before clamping tubes
- when working with the patients, continue to monitor for changes in intracranial pressure
- be careful to monitor color changes in CSF; normal would be clear or straw-colored
Purpose & placement for a sequential compression device (SCD)
- to prevent the risk of blot clots in the lower extremity
- to promote venous return
- full leg SCD is placed at the mid-thigh
- lower leg SCD is placed just distal to the patellar tendon
- both are usually applied to bilateral lower extremities
Indications for a sequential compression device
- patients who are at a high risk for bleeding (i.e. multiple trauma victims)
- patients who are at increased risk for DVT due to prolonged bedrest or venous insufficiency
- patients receiving anticoagulant therapies
- patients who have limited ambulation capacity
Clinical implications for a sequential compression device
- turn off machine and unwrap from extremities for mobilization
- place back on patient after therapy session
Purpose & placement for a continuous passive motion machine
- to promote movement and attempt to reduce loss of Range of Motion (ROM) after surgery
- mainly used after joint replacement surgery in the hip or knee
- limitation of lost ROM following a surgical procedure
- placed on the target joint with the pivot point at the joint center
Indications for a continuous passive motion machine
- promotion of cartilage growth and healing during NWB precautions
- may be used following fixation of fractures, joint sepsis, ligamentous reconstruction of the ACL, or other surgical procedures
- often seen post total knee arthroplasty
Clinical implications for a continuous passive motion machine
- CPM will often come with a specific protocol from the surgeon or MD
- initially set to 0-40 degrees as tolerated, increasing 10 degrees per day
- CPM is ideally used 6-8 hours per day, depending on patient tolerance
Purpose & placement for a pulse oximeter
- to monitor oxygen saturation at rest and during activity
- ear lobe, finger, toe, forehead, or bridge of nose
Indications for a pulse oximeter
- acute respiratory patients
- patients on medications which may impair respiratory function
- patients who have undergone surgery, transplant, or are otherwise medically unstable
Clinical implications for a pulse oximeter
- use clinical judgement to determine if patient’s oxygen saturation needs to be continually monitored
- therapist can connect/disconnect pulse oximeter
- will often set off alarm or be misread when patient is using hand/finger/foot during therapy session