Lines, Tubes and Drains Flashcards
What is a peripheral IV line?
allows continuous access to venous system for meds, fluids etc.
consider avoiding BP over IV site
What is a PICC line?
peripherally inserted central catheter
inserts at: antecubital fossa/brachium
terminus: SVC
What is important to remember about PICC?
no BP over picc or proximal due to risk of blood clot in vein or thrombophlebitis
What is a Central venous catheter?
used for med, fluid administration that might not be able to go in smaller veins
higher risk of infection
Where does CVC insert?
internal jugular, subclavian or femoral vein
terminates in SVC
What is a non tunneled dialysis line?
quinton catheter- inserts in IJ, SC or femoral vein ends in central venous system
What are PT implications of a non tunneled dialysis line in femoral vein?
suggested that hip flexion greater than 30 degrees and other activity limitations due to length of line
What is a tunneled dialysis line?
longer term line with decreased risk of infection because line is tunneled beneath skin before entering vein
What are PT implications for tunneled dialysis line?
if located in UE avoid extremes of ROM
What is an Aline?
used for continuous blood pressure monitoring and ABG
Where is insertion usually of a line?
radial, brachial or femoral artery
terminates: short line, so several cm into the artery
What is a level transducer of an aline?
it measures the pressure and flushes system out
Where is the level transducer located?
The phlebostatic axis is the reference point for zeroing the hemodynamic monitoring device.
What are PT implications for an Aline?
range of motion may be limited at that joint and if you are mobilizing is that affecting the waveform of aline
Can pts with a femoral a line mobilize?
yes as long as line is secure and pts hemodynamic response is appropriate
just be very careful
What else can a central venous catheter do?
used with a transducer it can give central venous pressure and with other clinical signs can measure total body fluid balance
What is important to remember about CVC numbers?
may not be useful or accurate during mobilization
What is pulmonary artery catheter?
used to measure a variety of things like: CO, PA pressure, RA pressure, MVO2
Where is insertion of PAC?
insertion: peripherally IJ, rarely SC and femoral
terminus: branch of pulm artery
level of transducer at phlebo axis
What is a normal Central venous pressure?
2-5 mmHG
What is normal right atrial pressure?
2-8 mm HG
What is normal pulmonary artery pressure?
20-30 mmHG
What is normal cardiac output?
4-8 L/min
What is cardiac index ?
measures of heart performance, blood from left ventricle to body surface
norm: 2.6- 4.2 L/ min
What is critical value for CI?
if less than 2.2 consider cariogenic shock
What is a chest tube used for?
in plural space: the tube may remove air, blood or pleural fluid and/or infectious fluid
in mediastinum: tube drains fluid, usually post cardio thoracic surgery
Where is chest tube insertion?
through intercostal space and terminates or plural space or mediastinum
What are three settings a chest tube can be on?
suction, water seal or clamped
What are PT implications?
maintain drainage collection upright and below insertion level
no restrictions on ROM
switch from suction to water seal during mobility?
When can there be an emergency with chest tube?
if there is a disconnect in system such as chest tube falling off
What is an air leak?
when air comes through the chest tube to the collection system, can be normal during a pneumothorax
What are three types of surgical drains?
blake, jackson pratt or hemovac
What is an intra aortic balloon pump?
mechanical device used to decrease myocardial oxygen demand and increase coronary artery perfusion
How does this device work?
inflates during diastole in coordination with the cardiac cycle, deflates during systole
Where does ballon pump insert?
peripheral artery, usually femoral
terminates: descending aorta
What are PT implications for ballon pump?
most pts on this are on bed rest, no ipsilateral hip flexion greater than 30
What is important to remember about a temporary pacemaker?
leads must be screwed in before mobility check orders from MD
What kind of feeding tubes are temporary?
NG or NJ
Which kind of feeding tubes are more permanent?
g tube or j tube inserted percutaneous to reduce risk of aspiration can lead to GI bleed, skin breakdown
When is Total parental nutrition used?
reserved for patients who cannot use their GI tract due to dysmotility, ischemia, obstruction or surgery
administered through venous access line
What are two types of ICP monitors?
ICP bolt and ventriculostomy ( can CSF)
What are PT implications for ICP?
watch for waveforms as this may be a sign of cerebral hypoxia or ischemia
if ICP elevations over 5 mins notify RN
keep HOB at 30 degrees
What is an endotracheal tube?
temporary maintenance or airway potency and delivery of mechanical ventilation
What is a tracheostomy tube?
“trach” inserted near thyroid cartilage and used for intermediate or permanent airway management
Are trachs used with technical vents?
sometimes but not always
How much air does a regular nasal cannula deliver?
can deliver between 0.25-6.0 L/min
FiO2 increases by 4% liter per min
What is a high flow nasal cannula?
up to 60 L/min
FiO2- 21%-100%
benefits: humidified, reduced entrainment of room air, can eat, drink talk easier than with a mask
How much air can a simple mask deliver?
6 -10 L/min
35-50% fiO2
can’t use with a trach
What is a venturi mask?
provides .24-50% FiO2
useful for mobility if pt doesn’t require more than 50% FiO2
