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Cardiopulmonary PT > Lines and Tubes > Flashcards

Lines and Tubes Flashcards

1
Q

Why should patients be mobilized early in the ICU?

A
  • Reduces hospital stay/costs

- Improves patient’s QoL

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2
Q

What 3 things should be considered when observing a patient’s lines and tubes?

A
  • Where do they originate and terminate?
  • What are they for?
  • How do they affect my treatment?
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3
Q

How does a pulse oximeter work?

A
  • Emits 2 wavelengths of light
  • Photo detector measures difference between light absorbed during systole and diastole
  • Estimates arterial % SaO2
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4
Q

How can a pulse oximeter be assessed for accuracy?

A
  • Compare pulseOx HR to manual HR
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5
Q

What are 5 factors that can affect accuracy of pulse oximeters?

A
  • Cold fingers
  • Nail polish
  • Darker skin
  • Motion
  • Cardiac arrhythmias
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6
Q

By what 2 methods can supplemental oxygen be delivered to a patient?

A
  • Nasal cannula

- Mask

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7
Q

What is the concentration of supplemental O2 delivered by a nasal cannula?

A

22 - 44 %

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8
Q

How many liters of oxygen require a high flow oxygen system?

A

More than 6L/min

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9
Q

Why may a nasal cannula be preferred to a mask?

A
  • More comfortable
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10
Q

What O2 concentrations can the air of a mask unit be increased to?

A

35 - 55 %.

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11
Q

How is the amount of oxygen in air measured?

A

FiO2

Fraction of inspired oxygen

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12
Q

What is the benefit of a partial non-rebreather mask?

A
  • Higher FiO2 with less flow
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13
Q

What are the typical FiO2 for 6L/min, 7L/min, and 8 - 10 L/min for a partial non-rebreather mask?

A

6L/min: 60 %
7L/min: 70 %
8-10 L/min: 80+ %

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14
Q

What is the purpose of a nasopharyngeal tube?

A
  • Suctioning of patients with poor cough and retained secretions
  • Connects nose and the upper airway directly
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15
Q

What are the two methods used to provide a sealed system for mechanical ventilation?

A
  • Endotracheal tube

- Tracheostomy

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16
Q

What is an endotracheal tube?

A
  • Inserted into trachea through mouth
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17
Q

What is a tracheostomy?

A
  • Surgical procedure
  • Incision made in tracheal rings
  • Tube inserted
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18
Q

Where are endotracheal tubes typically used?

A
  • ICU

- Pulmonary specialty areas

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19
Q

What risk is related to endotracheal tubes?

A

Damage to vocal cords.

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20
Q

What should be done if an endotracheal tube is pulled from a patient?

A
  • Check breathing

- Apply O2 or artificially breath for patient until re-intubated.

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21
Q

What are 2 advantages of tracheostomy over endotracheal tubes?

A
  • Decreased risk of vocal cord or tracheal injury./
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22
Q

What should be done if an endotracheal tube is accidentally removed?

A
  • Apply O2 or artificially breath for the Pt until the tube can be re-inserted
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23
Q

What are the 2 advantages of a tracheostomy button?

A
  • Maintains open stoma

- Allows direct suctioning

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24
Q

What are 3 advantages of a Passy Muir Speaking Valve?

A
  • Promotes use of upper airways
  • Assists verbal communication
  • Assists coughing
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25
Q

What are 2 requirements for the use of Passy Muir Speaking Valves?

A
  • SaO2 must be > 90 for all day use

- Must have a high humidity tracheal collar.

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26
Q

What are the 2 advantages of using a trachestomy collar?

A
  • Humidifies/ moisturizes air

- High flow O2

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27
Q

What ranges FiO2 can be used on a trachestomy collar?

A

21 - 100 %

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28
Q

What type of system should be utilized when ambulating with a trachestomy collar?

A
  • Venturi system
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29
Q

What are 4 general advantages of artificial airways?

A
  • Prevent airway obstruction
  • Protect airway from aspiration
  • Facilitate suctioning of sputum
  • Closed system for mechanical ventilation
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30
Q

What are 5 general disadvantages of artificial airways?

A
  • Cough less effective
  • Reduced ciliary motion
  • Interferes with communicaiton and nutrition
  • Bypasses respiratory defense mechanism
  • Tracheal stenosis
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31
Q

Is ventilation a contraindication to PT/ mobility?

A

No.

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32
Q

What 2 factors determine if a patient can receive therapy when on a mechanical ventilator?

A
  • Medical stability

- Mental status

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33
Q

Since the movement of artificial airways can irritate the patient’s tissues, what considerations should you make during ambulation?

A

Stabilize tube.

- May need assistance

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34
Q

What should be done if the patient’s tube becomes dislodged during ambulation?

A
  • Use manual ventilation to ventilate the patient
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35
Q

What are 5 uses of Ambu bags?

A
  • Manually ventilate patients when ambulating
  • Ventilate during suctioning
  • Stimulate a cough
  • Supplemental O2
  • Increase volume of air during a breath
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36
Q

What is the focus of PT usually in patients with artificial airways?

A
  • Mobilization

- Clearance techniques

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37
Q

How should the PT monitor a patient with an artificial airway during treatment? (3 things)

A
  • Make sure airway is stable before treatment
  • Check breath sounds before, during, and after treatment
  • Make sure tube does not change position
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38
Q

Are air leaks around a trach tube normal during mobility exercise?

A

Yes

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39
Q

What are 4 indications for the use of chest tube?

A
  • Pneumothorax
  • Hemothorax
  • Pleural effusion
  • Empyema
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40
Q

How is a chest tube held secure?

A

Sutured into place.

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41
Q

What 3 cavities are chest tubes typically inserted into?

A
  • Pleural space
  • Mediastinum
  • Pericardium
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42
Q

Following what surgery are mediastinal and pericardial tubes typically utilized?

A

Open heart surgery

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43
Q

`Where are chest tubes typically inserted?

A
  • Between 4th and 5th rib at mid or anterior axillary line posteriolateral to border of pec major
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44
Q

How should a chest tube patient be monitored by the PT? (3 ways)

A
  • Check vitals
  • Watch for bubbling in chambers (especially with movement)
  • Make sure tube isn’t kinked or blocked
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45
Q

Pts with chest tubes can participate in most treatment; what is the one consideration?

A
  • Make sure draining system is kept below the level of the insertion site and suction can continue
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46
Q

What 4 interventions should a PT focus on during treatment of a patient with a chest tube?

A
  • Position changes
  • Shoulder ROM
  • Ambulation
  • Deep breathing exercises
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47
Q

What 5 measures are typically displayed on an EKG?

A
  • HR
  • RR
  • SaO2
  • BP
  • EKG
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48
Q

If telemetry can’t be used while ambulating a patient, what can be used instead?

A

A pulse oximeter.

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49
Q

What should be checked if a PT noticed an abnormal EKG?

A

Make sure all the leads are in place.

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50
Q

What are 3 types of pacemakers?

A
  • Epicardial
  • Endocardial
  • Temporary
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51
Q

Where is an epicardial pacemaker located?

A
  • Sewn or screwed into the heart muscle during open heart surgery
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52
Q

Where is an endocardial pacemaker located?

A
  • In infraclavicular pocket

- Leads from pacemaker attach to right atrium and ventricle

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53
Q

In what settings are temporary pacemakers typically used? Where do they attach?

A
  • Used in acute care following surgery

- Sewn outside of heart, and wires exit below xiphoid process

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54
Q

What is an ICD?

A

Automated Implantable Cardioverter-Defibrillator

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55
Q

What is an ICD used for?

A

Shocks the heart into a normal rhythm if it begins to undergo lethal arrhythmias.

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56
Q

What should a PT consider with a patient with an ICD?

A
  • Make sure heart rate stays at least 10 beats below the point at which it activates.
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57
Q

Where are subclavian pacemakers and ICDs typically located?

A

Side of non-dominant upper extremity

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58
Q

What are ROM restrictions due to SCPM and ICDs?

A
  • Shoulder FLX/ ABD limited to 90 degrees

- No extreme shoulder EXT

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59
Q

What may be limited by the weight-bearing restrictions of a pacemaker/ ICD?

A
  • Use of an assistive device
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60
Q

Where should pressure not be applied during treatment in a patient with a subclavian PM or ICD?

A

Axilla.

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61
Q

Since temporary pace makers do not increase HR with exercise, what scale should be used to measure exertion?

A

RPE.

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62
Q

What is an intra-aortic ballon pump? When does it inflate/ deflate?

A
  • Catheter with ballon attached placed in aorta via the femoral artery
  • Deflates during systole to allow passage of blood
  • Inflates during diastole to prevent backflow.
63
Q

Where are intra-aortic ballon pumps typically used?

A
  • ICU
64
Q

What artery is particularly assisted by intra-aortic ballon pumps?

A

Inflation of ballon during diastole prevents backflow so that blood may flow into coronary artery.

65
Q

What load in the left ventricle is decreased by the intra-aortic ballon pump?

A
  • Afterload

- (amount of force needed to eject blood from the ventricle)

66
Q

What joints of the patient may be mobilized when an IABP is being utilized?

A
  • All UE joints as tolerated
  • All contralateral LE joints as tolerated
  • Ankle and foot of LE with catheter
67
Q

Besides mobilization of joints, what is the other focus of PT intervention in a patient with an IABP?

A
  • Prevent pulmonary impairments
68
Q

If the IABP becomes dislodged WHAT DO YOU DO?

A
  • Apply pressure

- Call for the nurse

69
Q

What is another name for a Swan Ganz Catheter?

A

Pulmonary Artery Catheter (PAC)

70
Q

What is the use of the PAC?

A
  • Monitors cardiac function in patients who are staying in the ICU long-term
71
Q

What does a PAC measure specifically? (5 measure)

A
  • Hemodynamics
  • Right arterial pressure
  • Pulmonary artery pressure
  • Pulmonary artery wedge pressure
  • Cardiac output
72
Q

How is a PAC inserted?

A
  • Through large peripheral vein, and guided through right side of heart to pulmonary artery
73
Q

What are typical PAC pressures in the: RA, RV, PA (Systolic). PA (diastolic), and Pulmonary capillary wedge pressure?

A 
RA: 0 - 8 mmHg
RV: 8 - 12 mmHg
PA (Sys): 15 - 30  mmHg
PA (Diast): 5 - 15 mmHg
PCW: 4 - 15 mmHg
74
Q

What precautions should a PT take in a patient with a PAC before treatment?

A
  • Ask someone if the patient is good to go
75
Q

When should a PAC patient never be mobilized?

A

If pulmonary capillary wedge pressure is being measured

76
Q

What level should the PAC transducer be kept at for accurate readings?

A
  • 4th intercostal space
77
Q

What are 4 complications related to PACs?

A
  • Infections
  • Line related sepsis
  • Thrombus
  • Pulmonary infarct/ pulmonary artery rupture
78
Q

What are pigtail catheters typically used for? Why are they called pigtail catheters?

A
  • Placed in heart or lung to drain fluid

- Curved end (pigtail) prevents puncture

79
Q

What helps control the rate of drainage of a pigtail catheter?

A
  • A stopcock.
80
Q

What PT implications are there for a patient with a pigtail catheter?

A
  • Ask a professional to see if the patient can get up and be moved around
  • Consider that the underlying pathology may limit the aggressiveness of your PT treatment.
81
Q

What are aterial lines/ catheters typically used for?

A

The monitoring of BP, arterial blood gases, and pH>

82
Q

What 2 other devices is the catheter typically attached to?

A
  • Transducer

- Pressurized flush device

83
Q

What are 4 common sites of aterial lines/ catheters?

A
  • Radial artery
  • Femoral artery
  • Brachial artery
  • Dorsalis pedis artery
84
Q

Why may a patient with an arterial line be immobilized?

A

To avoid kinking the line.

85
Q

What precaution should a PT take when treating a patient with an arterial line?

A
  • weight bearing and joint ROM are limited near the site of insertion
86
Q

If a patient is stable with an arterial line, what activities may they participate in?

A
  • All interventions
87
Q

What will cause a patient with an arterial line to be strictly on bed rest? (2 possibilities)

A
  • Catheter in sheath

- Femoral artery line (hip flexion also limited to 30 degrees)

88
Q

What type of arterial line will making standing or gait uncomfortable?

A
  • Dorsal pedis line
89
Q

What are 3 complications related to arterial lines?

A
  • Bleeding
  • Infection
  • Lack of blood flow to tissues supplied by artery
90
Q

If the transducer is placed above or below the 4th intercostal space, what complications may arise?

A

Above: BP falsely high
Below: BP falsely low

91
Q

If an arterial line is pulled out, what is procedure?

A
  • Apply pressure

- Call for help

92
Q

What are the 3 main types of venous catheters?

A
  • Peripheral intravenous
  • Central intravenous
  • Peripherally inserted Central Catheter
93
Q

Where are IVs typically inserted?

A

Into a peripheral vein in the hand or forearm

94
Q

What are 4 uses of IV lines?

A
  • Drugs administration
  • Fluids administration
  • Blood transfusion
  • Obtaining venous blood
95
Q

What is a common complication of IV?

A

Infiltration if IV is inserted into tissue instead of a vein.

96
Q

How long does an IV last?

A

3 - 5 day.s

97
Q

If an IV line alarm sounds, what should be done?

A
  • Check with nursing
98
Q

What are 5 indications for central catheter use?

A
  • Diagnostic information obtained by measuring central venous pressure and easy obtainment of blood samples
  • Administration of medications that are caustic to peripheral veins
  • Access when no peripheral veins are available
  • Long term medications or parenteral nutrition
  • Hemodialysis or plasmapheresis
99
Q

What 4 veins are central venous catheters typically inserted into?

A
  • Subclavian
  • Internal/ external jugular
  • Femoral vein
100
Q

Are veinous catheters rigid or flexible?

A

Flexible

101
Q

How are venous catheters held in place?

A
  • Sutures

- Staples

102
Q

What is a long, slender, small, flexible tube that is inserted into a peripheral vein and advanced until it reaches a large vein in the chest?

A

PICC line (peripherally inserted central catheter)

103
Q

What are 3 advantages of a PICC line over a standard central catheter line?

A
  • Less infection rates
  • Decreased risk of complications
  • Can remain in place for long periods of time
104
Q

Where are PICCs inserted, and where do they typically terminate?

A
  • Begin in a vein in the upper arm

- Terminate near the vena cava

105
Q

What is a clinical implication of a patient with a PICC line?

A
  • Nothing tight on the affected ARM

- No blood pressure

106
Q

What is a PCA pump?

A
  • Patient controlled analgesia
107
Q

What are 3 clinical implications for a patient with a PCA?

A
  • Only let the patient deliver the medication
  • Inform the nurse if the patient is unresponsive
  • Monitor blood pressure
108
Q

What are 5 categories of non-vascular lines and tubes?

A
  • GI
  • Renal
  • Urinary
  • Neurological
  • Intergumentary
109
Q

What patients use total parenteral nutrition?

A

Patients who can’t use GI tract.

110
Q

How is nutrition injected in a TPN line?

A

Through the central venous line.

111
Q

What are 4 feeding tubes?

A
  • Total Parenteral Nutrition (TPN)
  • Nasogastric tube (NG)
  • Dobhoff (Feeding) Tube
  • Percutaneous Endoscopic Gastrostomy/ Jejunostomy (PEG/PEJ) tube
112
Q

What is the purpose of a nasogastric tube?

A
  • Empties stomach of gas and digestive fluids

- Also for feeding

113
Q

Where does a NG tube insert and terminate?

A

Inserts: Nostril
Terminates: Stomach

114
Q

What patients recieve a Dobhoff tube?

A
  • Short term feeding
  • Patients who can’t chew or swallow
  • Functioning GI tract
115
Q

Where does a Dobhoff tube insert and terminate?

A

Inserts: Nostril
Terminates: Beginning of small intestines

116
Q

What is a percutaneous endoscopic gastrostomy/ jejunostomy?

A
  • Placement of tube in stomach or jejunum for longer term nutriiton
117
Q

What should be checked in a patient with an NG tube before ambulation?

A
  • Suction
118
Q

How should a patient NOT be positioned after eating with an NG tube?

A
  • Supine
119
Q

What should be done if a patient begins to vomit with their NG tube detached?

A
  • Reattach that thing
120
Q

How should a patient be positioned during feeding with a Dobhoff tube?

A
  • NOT flat.
121
Q

Can a Dobhoff tube be disconnected for ambulation/ mobility?

A

Yes. Check with nursing first.

122
Q

What consideration should be given to a paitent recently post-op for a PEG/PEJ tube?

A

The area of insertion may be tender/ sore.

123
Q

Can a PEG/PEJ tube be disconnected for mobility/ ambulation.

A

Yes.

124
Q

What is a colostomy?

A

Fecal matter drains from the colon through the abdomen to be collected in a pouch.

125
Q

Placement of what should be considered carefully in a patient with a colostomy?

A

Gait belt

126
Q

What are hemodialysis and plasmapheresis?

A
  • Removal of toxic waste from blood stream with renal failure to control fluid. electrolyte, and pH balance.
127
Q

What lines are used hemodialysis and plasmapheresis?

A

Central venous lines or ateriovenous fistula.

128
Q

How often and for long is hemodyalysis/ plasmapheresis done?

A
  • Every other day for 3 - 4 hours
129
Q

What is continous venovenous hemofiltration?

A
  • Waste products continuously removed to prevent large fluid shifts
130
Q

When is plasmapheresis indicated?

A

When the plasma cannot carry antibodies and nutrients to tissues/ remove wastes

131
Q

What is plasmapheresis?

A

Blood cells are removed/ replaced

132
Q

What measure should not be taken on an arm with AV shunt?

A

BP

133
Q

What time management should considered with a patient receiving dialysis?

A
  • Schedule treatment around dialysis treatments
134
Q

How may a patient’s treatment session be effected when the patient is not receiving dialysis at the time of treatment?

A
  • May still have low endurance
135
Q

Can a patient be treated if they are receiving CVVH?

A

Possible. Depends on placement of line and medical stability.

136
Q

What is a foley catheter?

A

Placed directly into bladder to assist in evacuation of urine.

137
Q

How can infection be avoiding when mobilizing a patient with a foley catheter? (3 points)

A
  • Tape the tubing to the patients leg
  • Keep the tubing clear of everyone’s feet
  • Keep the bag below the level of the bladder to prevent backflow.
138
Q

What is an external ventricular drain?

A
  • Tube placed into ventricles of brain to drain CSF to relieve pressure, blockage, etc.
139
Q

Where should an external ventricular drain be placed?

A

External auditory meatus

140
Q

What does an ICP monitor measure?

A

The pressure surrounding the brain.

141
Q

What should be done with a patient with an external ventricular drain before mobility? Afterwards?

A
  • Consult with MD to ensure ICP is controlled
  • Clamp drain before mobilization
  • Relevel drain before reopening after mobility
142
Q

What pressure should be maintained when using an ICP monitor?

A

20 - 25 mmHg

143
Q

How should the head be positioned with an ICP monitor?

A
  • Bed in 30 degrees flexion at head

- Head in neutral

144
Q

What is a surgical drain?

A

Tube inserted into surgical site for draining.

145
Q

How do most surgical drains operate? What are 2 specific methods?

A
  • Suction mechanism
  • Hemovac
  • Jackson-Pratt drain (looks like grenade)
146
Q

Can a patient with a surgical drain be mobilized?

A
  • Yes

- Pin drain to gown

147
Q

What is a wound vac’s 4 functions?

A
  • Removes slough/ exudate from a wound
  • Maintains moisture
  • Increases circulation
  • Reduces edema and bacteria
148
Q

Can a patient with a wound vac be mobilized?

A

Yes, so long as there is enough battery power.

149
Q

How should a wound vac be monitored?

A

Check for breaks in seal.

150
Q

How should a wound vac be disconnected?

A
  • Clamp boths ends

- Clean both ends using a glove and gauze

151
Q

What patients commonly wear compression boots?

A

Those at risk for DVT.

152
Q

Can a patient with compression boots be mobilized?

A
  • Yes

- Remove before mobilization

153
Q

If a patient is confused, are compression boots appropriate?

A
  • No

- Consider other methods of DVT control

154
Q

If a patient is very edematous, what considerations should taken when using compression boots?

A

Use adjunct compression therapy to prevent pitting edema.

Cardiopulmonary PT (10 decks)

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