Medical Accessory Equipment Flashcards
3 main functions of nasogastric (NG) tubes
Feeding - pt’s who may require an NG tube for feeding include those affected by trauma, disease, altered state, surgical procedure
Decompression - used for pt’s who require removal of gas and secretions by suction, used to prevent vomiting in pt’s who have recently had surgery
Radiographic examination - of the stomach with a thin barium or water soluble cm, cm is injected by hand into the existing NG tube or oral cm can be given to pt’s being prepped for CT exam
Types of NG tubes (3) and their uses
Dobbhoff - most commonly used NG tube for feeding
Levin - most commonly used for NG tube for decompression, single lumen with several holes near tip
Salem-Sump - commonly used for decompression, double lumen, one is used to remove gastric contents and the other functions as an air vent
3 main functions of nasoenteric (NE) or nasointestinal or (NI tubes)
Decompression - used to remove gas/fluid that occurs post operatively or as a result of bowel obstruction
Radiographic examination
Feeding
Reasons for using a NE tube instead of a NG tube
- decrease or absence of peristalsis in the stomach but not in the intestines
- delayed gastric emptying
- pt has has a gastric resection
Types of NE tubes and their uses
Miller-Abbott - double lumen tube, one lumen is for drainage and the is for a balloon (balloon is weighted to simulate bolus of food and promotes peristalsis to advance the tube into the small bowel)
Harris - single lumen with one opening
Cantor - single lumen with one opening
After insertion of NG/NE tube radiograph is taken to
- confirm placement of tube
- ensure food isn’t administered into the lungs
- tube has not curled or kinked onto itself
- CXR or single view of the abdomen is used to confirm placement
- adjust centring to include tip of radiopaque NG tube
- read pt history on req indicating the reason for exam
What is a Electrocardiograph (ECG or EKG)
Device that measures the electrical activity of the heart and displays the info graphically in the form of waves on a paper tracing or monitor screen
Displays waves categorized in P Q R ST and sometimes U
Graph produced is called a electrocardiogram
detect and record cardiac irregularities
Why do we use an ECG/EKG
- standard practice in most critical care units
- patients in the ER who suffer from acute medical problems (angina/arrhythmias)
- pt’s with traumatic problems
How an EKG/ECG works
Electrodes/leads - most ER pt’s have 3 but can have up to 12, they are electrical contacts that receive tiny electrical signals produced in the pt’s heart, are stuck to the pt by an adhesive patch
Cables/wires - connect to the electrodes and display the signals on an electronic display unit
Monitor - displays heart electrical signals
Artificats and complication with ECG/EKG equipment
- patches can be left on pt’s skin for easy reattachment but will leave artifacts on the x-Ray (ok to be on image)
- cables/wires will also leave large artifacts and need to be placed on pt’s shoulder out of the way (not ok to be on image)
- pt movement could cause abnormal ECG tracing reports
- if electrodes become detached a flat line can result, always check pt and equipment before initiating a code
Location of the leads
- 2 leads are placed on the anterior part of chest on either side of the sternum at level of 2nd intercostal space
- 3 lead is attached on the side of the chest at the level of the 6/7th intercostal space
- white lead = right side of chest
- black lead = left side of chest
- green lead = side of chest
- pt movement will cause abnormal tracing so pt must remain still while EG is performed, if you unattach the pt be sure to reattach them when you are done
Indications for chest tube insertion
Hemothorax - accumulation of blood in the pleural cavity
Pneumothorax - accumulation of air/gas in the pleural cavity
- these can result from illness, injury, or thoracotomy procedure
What is thoracotomy
- Surgical creation of an opening in the chest cavity
- Performed to diagnose or treat disease or injury to the lung
- Chest tube is attached to a water sealed drainage unit to remove any air or fluid from the pleural cavity
- done to reestablish the correct intrapleural pressure and allow lungs to expand normally
Chest tube location for pneumothorax
- to remove air or gas the tube is inserted through the anterior and superior surface of the chest wall
Chest tube location form hemothorax
- remove fluid/blood the tube is inserted through the posterior and inferior surface of the chest wall
Equipment for Chest tube
Water sealed drainage system is established by connecting the chest tube that originates in the pleural cavity to a clear tube that ends in a chamber containing sterile water or normal saline solution
Care for pt with chest tube
- drainage unit must be kept below level of pt’s chest
- keep tubing from pleural cavity as straight as possible to avoid kinking
- never clamp chest tubes, all connections must be lightly taped to the tubing
- do not empty water sealed chamber or move them above insertion site
- if it is bubbling this could indicate a leak in the system notify nurse ASAP
- do not allow tension to be placed on the chest tube be when positioning pt it could cause a tubing to seal off or be kinked
- disturbance of the tube may result in a rush of air into the pleural space reversing the intent of the treatment and potentially causing a collapsed lung
What are Central Venous catheters (CVC) and Central lines
- tubes that are surgically inserted into a vein in the central circulation system (usually superior vena cava)
- are catheters that provide access on a repeated or continuous basis
Function/purpose of CVC’s
Administer chemo or long term drug therapy
Provide total parental nutrition (bypass alimentary canal)
Dialysis
Blood transfusion
Facilitate the drawing of blood for lab analysis
Allow venous pressure monitoring
Classifications of CVC’s
- Short or long-term non-tunneled external catheters = PICC line
- Long term tunneled external catheters = Hickman, Groshong, Raaf
- Long term implanted infusion ports = port-a-cath
What is a tunneled central line or CVC
- long term intravenous deceive inserted into the chest
- used to administer meds and blood products or draw samples form your blood w/o having to regularly poke veins
- tip of CVC is located in the large vein near heart (vena cava)
What is a tunneled CVC
- inserted into an incision in the chest, tunneled through the fatty tissue then threaded into a vine in the neck and advanced to the vena cava
- tunnel under the skin helps to hold the catheter in place and prevent infection
Common characteristics of Central Lines and CVC’s
- constructed of special material that provides the needed rigidity for placement and lowers the incidence of blood clot formation (complication of CVC’s)
- radiopaque strips or radiographic distal ends allow radiographic verification of CVC placement
- can be single or double lumen
- distal tips of all CVC rest in the vena cava heart the right atrium of the heart
Location of non-tunneled CVC’s
Subclavian vein
Internal/external jugular vein
Femoral vein
Basilic or cephalic veins in arm (PICC lines)
