Medical Devices PPT Flashcards
What is another name for a chest tube?
Thoracostomy or Intrapleural Tube
Where is a chest tube inserted?
Fluid accumulates near lung base (5th to 6th intercostal space @ midaxillary)
Air rises to upper pleural space (2nd to 3rd intercostal @ midclavicle)
Purpose of a chest tube
Drain intrapleural space & mediastinum
– Fluid/air
***A chest tube is inserted to reestablish intrapleural pressure that may be caused by what various conditions?
Pneumothorax
Hemothorax
Pleural effusion
Empyema
What is Empyema?
Type of pleural effusion where fluid is affected
Negative pressure is disturbed
Lungs fail to expand or collapse
Tube is inserted to reestablish pressure
Chest tube attaches to
Watersealed drainage unit
Collects air/fluid to reestablish
the correct Intrapleural pressure & allows lungs to
expand
Tube remains below water level to
Maintain seal
Tube ends in a chamber containing
Sterile water or sterile saline
Patient inhales & air/fluid are drawn into
Dainage tube and ChamberInto
Various water-sealed systems are
Disposable
***Mediastinal drain (small chest tube)
After cardiac surgery
– Drains residual blood from Mediastinum to
prevent accumulation around Pericardium
2 Chest tubes
Y connector joins tubes near patient’s body and continues to drainage apparatus
How to Handling Chest Tubes
Keep tubing from pleural cavity to drainage chamber as straight at possible – prevent tension from being placed on tube
• Do not empty water-sealed chambers or raise them – it must remain below the patient’s chest @ all times
• Do not clamp chest tube
• If chamber is bubbling, notify patient’s nurse
immediately (indicates possible leak)
• Patient’s breathing changes or complains of chest pain, notify patient’s nurse immediately
CXR Images
Before and after insertion
– Proper insertion
• Verify tube can be removed
• Initial images to confirm lung expansion
• 2 hours after clamping to verify continued expansion
– After removal to confirm lung expansion
What is the purpose of an endotracheal tube (ETT)?
Mechanical ventilation or oxygen delivery
Upper airway obstruction
Impending gastric acid reflux or aspiration
Endotracheal tube (ETT) inserted
Through mouth into trachea (or through tracheostomy)
– After placed in trachea, cuff is inflated to keep airway open
– Establishes airway; prevents aspiration of foreign
objects
Where is the proper placement of the endotracheal tube?
5 to 7 cm superior to tracheal bifurcation (halfway between clavicles and carina {T5-T7}
CXR to determine
Proper placement
– 20% require repositioning
Atelectasis is
Collapsed lung
***If Endotracheal tube (ETT) tube is inserted too far
Enters the right bronchus causing a collapse of left lung or atelectasis
If Endotracheal tube (ETT) tube is too high
Air enters the stomach and regurgitation leads to aspiration pneumonia
What is the name of the catheter that is inserted into a large vein and has a variety of uses?
Central venous catheter
Venous access device
Hickman/Groshong (developer)
***What are some of the uses for the catheter mentioned in the previous question?
(Central venous catheter
Venous access device
Hickman/Groshong)
Administer chemotherapeutic and other drugs Parenteral nutrition Manage fluid volume Blood analysis and transfusion Monitor cardiac pressure
***Where is the preferred location for a central venous line?
SVC approximately 2 to 3 cm above the right atrial junction
Hickman & Broviac
***What are some of the common insertion sites for central venous lines?
Subclavian vein Internal jugular vein Femoral vein Antecubital area (PICC lines) Basilic vein Cephalic vein
***What type of line is a Swan-Ganz catheter?
Pulmonary arterial or PA line
***What is a pulmonary arterial line?
Single or multilumen CV line that contains a small electrode at distal end which is used to monitor pulmonary arterial pressure
It enters through right internal jugular and ends in the right pulmonary artery
***Who performs the insertion of a PICC line?
Radiologist
Nurse
Specially trained technologist
***What are some of the uses of a PICC line?
Prolonged antibiotic treatment
Home health care for extended treatment
Chemotherapy
Nutrition
PICC Line stand for
Peripherally Inserted Central Catheter
***Where is PICC line inserted?
Into patient’s arm and advanced into a central
vein (Subclavian to SVC)
• Basilic, cephalic or median cubital veins
What is an Implanted access device?
A device surgically implanted under patient’s skin in the chest wall or patient’s arm.
Tip lies in SVC
Used for drawing blood or administering medications/contrast
***What type of needle is used to access an Implanted access device (port)?
Huber needle
Implanted port
Frequent intravenous medications or transfusion
– Plastic, titanium or stainless steel
– Implanted into Subcutaneous tissue
***Catheter from port inserted into
Subclavian or internal jugular vein
Right Side Approach for Line Placement
Follow course of subclavian vein in a lateromedial direction
Right brachiocephalic vein
– SVC to right atrium
• Catheter is Right of vertebral column
• Does not cross _Midline___
Left Side Approach for Line Placement
Slightly longer catheter is required
Advanced lateromedially to left subclavian vein to
left brachiocephalic vein
– Vein courses horizontally
– Catheter crosses midline from left to right ending in SVC
What are the primary uses for a nasogastric tube?
Administration of medications
Gastric decompression
Removal of fluids from stomach after obstruction or trauma
What is the most common NG tube?
Levin tube: Single lumen with several holes near its tip
Sump tube: double-lumen tube
• Second opening is referred to as “Pigtail”
– Blue extension off of proximal end of tube
3 other types of NG tube are
Nutriflex tube
Moss Tube
Sengstaken-Blakemore (S-B)
Nutriflex tube
- Primarily for feeding
* Mercury-weighted tip
Moss Tube
• Triple-lumen tube
• One end has inflatable balloon to anchor in
stomach; 2nd lumen is for aspiration of fluid; 3rd
lumen is for duodenal feeding
Sengstaken-Blakemore (S-B)
• Triple-lumen tube
• 2 lumens with balloons
– Inflated for pressure on varices
• 3rd lumen used for lavage and monitors hemorrhage
– Pressures must be maintained @ all times
– Requires nurse to be with patient @ all times
– ICU patients
NE tube also called
Nasoenteric Feeding Tube
Entriflex or Dobhoff tube
• Narrow lumen tube
What are some uses for the nasoenteric feeding tube?
• Intestinal decompression • Introduction of mercury after insertion Feeding and hydration of patient Contrast administration Not used with SUCTION
***Nasoenteric feeding tubes are………and more ……………. than NG tubes.
Thinner
Flexible
NE tubes can stay in for
a longer period of time
NE tubes are positioned @
the level of 3rd portion of duodenum
3 Most common NE tubes are
Cantor: single-lumen
– Harris: single-lumen
– Miller: double-lumen
What is a PEG tube?
Gastric feeding tube
Surgical creation of opening into stomach
Percutaneous Endoscopic Gastrostomy – most common type
PEG tube placed
From inside of the stomach to external abdominal wall
What is the purpose of PEG tube?
Feeding a patient who cannot tolerate oral intake of
food
• Temporary/permanent
PEG tube is closed off after feeding with
clamp or plug-in adapter to prevent leakage of contents
– Tube is coiled and taped in place
PEG is inserted through
small incision into stomach or jejunum
– Endoscopy procedure
– Surgery
PEG tube is used for
long term nutrition
Defecogram also called
Defecography
Evaluation proctography
Dynamic rectal exam
Perform Defecogram
Defecation dysfunction
• No patient prep
• Instill barium directly into rectum using special
injector
• Patient seated laterally on a commercially
available radiolucent toilet in front of fluoro unit
Images acquired during Defecogram procedure
Lateral projection @ 1 to 2 images per second
(rapid sequence)
– Video recording may be done
Images evaluate of Defecogram
Measurements of anorectal angle & angle between long
axes of anal canal & rectum
