Lines & Tubes Flashcards
1
Q
What are the 6 benefits of ICU mobilization of patients?
A
- It’s Safe
- It’s Feasible
- Improves patient function
- Can reduce length of hospital stay
- Can reduce length of hospital costs
- Improves pt. Quality of Life
2
Q
Why is learning about equipment important?
A
It allows therapists to make…
- Informed decisions
- Safe choices
3
Q
What are the 3 Acute Care Equipment Objectives?
A
- Understand each item’s purpose
- Be aware of each item’s precautions
- Be aware of info needed prior to activity with acute care patients
4
Q
Upon entering a pt. room you should scan the environment. What 3 questions should you ask yourself?
A
- Where do all the lines originate/terminate?
- What are the lines for?
- How do they impact PT?
5
Q
What is the primary goal of ALL the lines and tubes?
A
Do NOT pull them out!! Ouch!
6
Q
What type of equipment will a PT see upon entering the pt. room?
A
- Pulmonary
- Cardiac
- Vascular
- Other
7
Q
What is considered “Other Equipment”?
A
- GI
- Renal
- Urinary
- Neurology
- Integumentary
8
Q
What is a Pulse Oximeter?
A
- It is a probe that emits 2 wavelengths of light.
- A photo-detector measures the difference between light absorbed during systole & light absorbed during diastole.
- This difference provides an estimate of arterial %SaO2.
9
Q
How can you determine the accuracy of a pt.’s HR that is measured by a Pulse Oximeter?
A
Take the pt.’s HR manually and then compare the two measures
10
Q
What factors limit the accuracy of Pulse Oximetry?
A
- Cold Fingers
- Nail Polish
- Darker Skin
- Motion
- Cardiac Arrhythmias
11
Q
What are the 2 main ways a pt. can receive Oxygen?
A
- Nasal Cannulas
2. Oxygen Mask
12
Q
What are the 2 types of Nasal Cannula Systems?
A
- Low flow oxygen system
2. High flow oxygen system
13
Q
What is a low flow Nasal Cannula oxygen system?
A
When the concentration of supplemental O2 is 24-44% (air ~21%)
14
Q
When would you use a high flow oxygen system?
A
When a pt. requires >6L/min of O2
15
Q
What is one reason a pt. may want to wear a nasal cannula instead of a mask?
A
Nasal Cannulas are more comfortable than masks
16
Q
What is one benefit of a mask over a nasal cannula?
A
A mask increases O2 concentration to 35-55%
17
Q
When documenting the use of an oxygen mask, flow rate should NOT be recorded. What should the PT record instead?
A
FiO2 (Fraction of Inspired Oxygen)
18
Q
What is a Partial Non-Rebreather Mask (PNRB)?
A
A mask with an O2 bag attached
19
Q
What are the benefits of the PNRB Mask?
A
- Offers higher O2
2. Requires lower flow of O2 for FiO2 need
20
Q
What type of pt. is usually prescribed a PNRB mask?
A
Pt. that is usually very ill
21
Q
What percentage of PNRB flow is indicated in the following: 6L/min? 7L/min? 8-10L/min?
A
60%, 70%, 80+% (respectively)
22
Q
- What is a Nasopharyngeal Tube
2. What is it used for?
A
- It is a tube that provides a direct connection between the nose and upper airway.
- It is used for the suctioning of pt.’s with poor cough and retained secretions
23
Q
What is another name for an Artificial Airway?
A
Oropharyngeal Airway
24
Q
What is the purpose of an Artificial (Oropharyngeal) Airway?
A
It prevents obstruction of the airway by…
- Moving the tongue anteriorly
- Facilitating suctioning
25
What are the 2 types of Mechanical Ventilation?
1. Endotracheal Tube (ETT)
| 2. Tracheostomy
26
What is the purpose of using mechanical ventilation (i.e. ETT and tracheostomy)?
1. Prevent upper airway obstruction
| 2. Provide a sealed system for mechanical ventilation
27
1. What is an Endotracheal Tube (ETT)?
2. When is it used?
3. What does it do?
1. Tube inserted into trachea through the mouth
2. When pt. is in respiratory failure (seen in the ICU and some pulmonary specialty areas)
3. Allows air to easily pass in & out
28
1. What happens if an ETT is pulled out accidentally (or on purpose if you're crazy)?
2. What should you do if it gets pulled out?
1. Can cause damage to the vocal cords
| 2. Check breathing and apply O2 or artificially breathe for pt. until re-intubated
29
1. What is a Tracheostomy?
2. When would it be indicated (AKA when is it used?
3. What does it do?
1. A surgical procedure where incisions are made in the tracheal rings & a tube is inserted
2. Acute & chronic conditions for a more permanent airway as seen with decreased vocal cord or tracheal injury
3. Maintains an open stoma & allows direct tracheal suctioning
30
What should you do if Tracheostomy gets pulled out accidentally?
Apply O2 or artificially breathe for pt. until trach tube is put back in
31
What are the 2 benefits of a Passy Muir Speaking Valve (PMSV)?
1. Promotes use of upper airway
| 2. Assists with verbal communication & coughing
32
Why must the PMSV cuff be deflated when the valve is on?
Because the pt. can't breathe if the cuff is inflated!
33
In order to wear the PMSV all day, what percent value should the pt.'s SpO2 be greater than?
90%
34
Who is indicated in the use of Speaking Valve Assessment?
Pt.'s on high humidity trach collar (HHTC)
35
What is a Trachestomy Collar?
A high flow O2 delivery system with high humidity (Note: humidity wars and moisturizes the air)
36
What is the FiO2 percent range for a Trachestomy Collar?
21-100%
37
What type of system can be used for ambulation with a Trachestomy Collar?
Venturi System
38
What are the 4 advantages of Artificial Airways?
1. Prevent airway obstruction
2. Protect airway from aspiration
3. Facilitate suctioning
4. Provides closed system for mechanical ventilation
39
What are the 5 disadvantages of Artificial Airways?
1. Cough is less effective
2. Reduced ciliary motion
3. Interferes with communication/ nutrition
4. Bypasses respiratory defense mechanisms
5. Tracheal stenosis
40
What are the implications for PT when using mechanical ventilation?
1. PT participation depends upon pt.'s medical stability and mental status (often sedated)
2. Ventilation is NOT a contraindication to mobility/ther ex
3. Assistance to stabilize trach tube may be needed due to irritation of airway with movement
4. If dislodged, use manual ventilation (ambu bag) to ventilate pt. & call for help!
41
What the heck is an Ambu Bag and why is it used?
```
Uses...
1. ICU and emergency situations
2. To manually ventilate patients
3. Stimulate a cough
4. Supplement O2
5, Increase normal volume of air during a breath
6. To ambulate a pt. without a portable ventilator
7. During suctioning
```
42
When treating a pt. with an artificial airway, what are some things a PT should know and/or do?
1. Know pt. can participate in ALL ther ex
2. Added emphasis on airway clearance & mobilization
3. Ensure airway is stable prior to tx
4. Listen to breath sounds before, during, & after tx
5. Air leaks around the trach tube is normal with mobility exercises
6. Excessive movement of tube should NOT occur so check it at all times. Stop tx & notify nurse if it moves a lot
43
What is a chest tube?
Any tube placed in the chest that is sutured into place
44
What is a chest drain?
A large catheter places within plueral space, mediastinum, or pericardium to remove fluid/air & restore respiratory function
45
Under what condition does a pt. usually receive a mediastinal/pericardial tube?
After open heart surgery
46
Name 4 diseases that would indicate use of a chest tube.
1. Pneumothorax
2. Hemothorax
3. Pleural effusion
4. Emphyema
47
What is the typical drain site for a chest tube?
1. Through the 4th or 5th rib, in mid or anterior axillary line
2. Site of entry posterior to the lateral border of the Pec Major
48
What are the PT implications for Chest Tubes?
1. Monitor Vitals
2. Watch for bubbling in chambers with mobility
3. Ensure tube is not kinked/blocked
4. Pt. can participate in all therapy provided drainage system is kept below the level of insertion & suction continues
5. Encourage position changes, shoulder ROM, ambulation & deep breathing exercises
6. If collection bottles fall over, right immediately & notify nurse
49
When is bubbling in chambers more pronounced?
During coughing and expiration
50
If bubbling is a new occurrence, what 2 steps should a PT take?
1. Notify nurse that a leak may have occurred
| 2. Consider a portable suction machine
51
What 5 pieces of information are displayed on an EKG monitor?
1. HR
2. RR
3. O2 Sat
4. BP
5. EKG
52
If you do not have telemetry when ambulating a pt., what else can the PT use to monitor HR and O2?
Pulse Oximeter
53
What is an Epicardial Pacemaker?
A pacemaker placed during open-heart surgery where electrodes are sewn or screwed into the heart muscle (wowzers!)
54
What is an Endocardial Pacemaker?
A generator placed in the infraclavicular pocket with pacer leads attached to the R atrium & ventricle
55
What is a Temporary Pacemaker?
A pacemaker used in acute care following cardiac sugery. It is sewn to the outside of the heart. Wires exit below the xiphoid process
56
What are the 2 main functions of the Automated Implantable Cardioverter-Defibrillator (ICD)?
1. Shocks/defibrillates the heart during lethal arrhythmias
| 2. Paces the heart with regular or overdrive pacing
57
Why is it important to know at what HR an ICD is activated?
To ensure the pt.'s HR remains greater than 10 BPM below that rate
58
What are the PT implications for a pacemaker and automated ICD?
1. Usually placed on side of non-dominant UE
2. Shoulder flexion/abduction limited to 90 degrees
3. No extreme shoulder extension
4. WB restrictions per MD
5. No pressure should be applied to axilla
6. Temporary pacemakers do NOT increase HR with exercise (use RPE instead)
59
What is an Intra-Aortic Balloon Pump?
A catheter with a balloon attached that is placed in the aorta via the femoral artery (used in the ICU)
60
What occurs when the intra-aortic balloon DEFLATES during SYSTOLE?
Cardiac output increases thus increasing forward flow and decreasing after load
61
What occurs when the intra-aortic balloon INFLATES during DIASTOLE?
Increases coronary artery and myocardial perfusion thus directing blood flow backwards into the coronary arteries
62
What are the PT implications for an IABP?
1. Bedrest
2. Increase bed height no more than 30 degrees
3. UE and contralateral LE exercises are okay (can move ankle & foot of involved leg)
4. Prevent pulmonary impairments
5. Quickly apply pressure and get help if IABP dislodges!
63
What is another name for the Swan Ganz Catheter?
Pulmonary Artery Catheter (PAC)
64
What is a PAC?
Flexible, balloon tipped catheter inserted by the MD in a large peripheral vein & guided through the R side of the heart to the pulmonary artery
65
What are 3 uses of a PAC?
1. Used to evaluate cardiac function & volume status
2. To monitor response to fluids, diuretics, and vasoactive drugs
3. For long term use in the ICU
66
What are the normal pressures for a PAC?
a. R Atrium
b. R Ventricle
c. Pulm Artery (systolic)
d. Pulm Artery (diastolic)
e. Pulm Capillary Wedge Pressure (wtf)
a. 0-8 mmHg
b. 8-12 mmHg
c. 15-30 mmHg
d. 5-15 mmHg
e. 4-15 mmHg
67
Name 5 complications of a PAC?
1. Infection
2. Line related sepsis
3. Thrombus
4. Pulmonary Infarct (rare)
5. Pulmonary artery rupture (rare)
68
What are the PT implications for PAC?
1. Do NOT mobilize pt. if pulm capillary wedge pressure is being measured
2. Check with docs/nurses to determine if it's okay to get pt. out of bed
3. If cleared for PT, pt. can participate in ALL therapy (pt, must be stable for mobility types of PT)
4. Keep transducer level at 4th intercostal space for accurate reading
5. Check swan position before and after moving pt.
69
What is a Pigtail Catheter?
A catheter placed in the heart of lung to drain fluid collections (i.e. tamponade, pericardial/pleural effusions)
70
What do the curved and and stopcock do in a Pigtail Catheter?
1. Curved end prevents puncture during insertion
| 2. Stopcock allows controlled drainage of collection
71
What should a PT consider before treatment if a pt. has a pigtail catheter?
Consider the pathology the pt. has and the negative impact on CO, ventilation, or gas exchange that is occuring
72
What is an arterial line/catheter?
A catheter in the peripheral artery connected to a transducer and pressurized flush device
73
What is an arterial line/catheter used for?
1. Continuous monitoring of BP
2. Drawing blood to monitor arterial blood gases & pH
3. Used in acute care
74
What are the common sites of insertion of an arterial line/catheter?
1. Radial Artery
2. Femoral Artery
3. Brachial (sometimes)
4. Doral Pedis (sometimes)
75
Why may a pt. be immobilized when they have an arterial line/catheter inserted?
To avoid kinking the line - Ow!
76
What are the PT implications associated with arterial lines/catheters?
1. Limited WB
2. Avoid joint movement/ROM near insertion site (so you don't dislodge line)
3. Pt. can participate in ALL PT interventions IF pt, is stable and line is secure
4. If catheter is in a sheath, pt. is ON STRICT BED REST! DON'T TOUCH!
5. Pt. may be on bedrest or limited to 30 degrees of hip ROM if it's a femoral line (check with hospital policy)
6. Gait/standing uncomfortable with dorsal pedis line
7. Always inspect catheter site prior to mobilization. Secure if necessry
77
Name 3 precautions for Arterial Lines.
1. Apply pressure to site immediately and call for help if line is pulled out
2. Keep transducer at 4th intercostal level. Re-calibrate following position change
3. Transducer BELOW heart means falsely HIGH BP. Transducer ABOVE heart means means falsely LOW BP
78
Name 3 complications of associated with arterial lines
1. Bleeding
2. Infection
3. Lack of blood flow o tissues supplied by the artery
79
What are the 2 primary types of Venous Catheters?
1. Peripheral Intravenous (IV)
| 2. Central Intravenous (Peripherally Inserted Central Catheter - PICC)
80
Where is a Peripheral IV inserted?
Into a peripheral vein typically in the hand or forearm (lasts 3-5 days)
81
What are the 2 main uses of a peripheral IV?
1. Immediate access for administration of drugs, fluids, and blood transfusions into circulatory system
2. To obtain venous blood
82
What is infiltration?
When the IV fluid goes into the tissue instead of the vein
83
What are the PT implications for a peripheral IV?
1. Certain meds must run continuously
| 2. If IV pump alarm sounds, check with nurse
84
What is a central venous catheter?
Flexible tube that is inserted into subclavian, internal/external jugular, or femoral vein and sutured/stapled in place
85
What are 5 indications for central venous catheter use?
1. Diagnostic info by measuring central venous pressure (CVP) & easy access to blood samples
2. Administration of meds that are caustic to peripheral veins
3. Access when no peripheral veins are available
4. Long term meds or parenternal nutrition (TPN)
5. Hemodialysis or plasmapheresis
