Patients with Tubes and Lines Flashcards
Anatomy review of Respiratory System
fxn: provide oxygen to body tissues for cellular respiration and remove the waste product carbon dioxide
Upper respiratory tract – nose, mouth, sinuses, pharynx, larynx
Lower respiratory tract – trachea, bronchial tree, lungs
Oxygen (general)
When O2 is absent, irreversible brain damage can occur within 4-6 minutes
21% of O2 supplied in room air maintains homeostasis
What is oxygen therapy?
The administration of O2 at a concentration that is greater than that which is found in the environmental atmosphere
Oxygen therapy (general)
1/3 of all patients in care settings receive O2 therapy at some level
Purpose is to increase O2 saturation in tissues when the saturation levels are too low due to illness or injury OR prevent or minimize the increased cardiopulmonary workload (Increased HR, BP, and RR)
What is Hypoxia?
def: inadequate amount of O2 at the cellular/tissue level
To compensate for hypoxia, RR, depth of breathing, BP, and HR increases
Experience shortness of breath and have to work harder to breath
Delivering O2 alleviates cardiopulmonary work and BP, HR< RR, and depth may return to normal
*** Brain, heart, lungs, and liver are most sensitive to hypoxia
Causes of Hypoxia
- Decreased Hgb level
- Diminished concentration of inspired O2
- Inability of tissues to extract O2 from blood
- Decreased diffusion of O2 from alveoli to the blood
- Poor tissue perfusion with O2 blood
- Impaired ventilation
Signs and symptoms of Hypoxia
- Restlessness
- Inability to concentrate
- Declined level of consciousness
- Dizziness
- Fatigue
- Agitation
- Bluish skin (cyanosis)
Oxygen Therapy continued..
O2 should be treated as a drug (7 rights) MUST be prescribed by physician Prescribed in dose/concentration
Liters per minute (LPM) – common flow rate is 2 LPM
FiO2 (Fractional concentration of O2)
As you increase Liter, increases ~ 4% O2
O2 is combustible, no smoking by O2
Methods of Delivery:
Low/medium flow
Nasal cannula
- Low flow device, most common device for mild hypoxia
- 1-6 LPM
Simple face mask
- Low/moderate flow device, used when moderate amount of O2 is needed
- Short-term O2 therapy
- 5-10 LPM
Methods of O2 delivery:
High Flow
Venturi mask – allows precise measurement of O2 delivered
Non-rebreather mask – critical patients
Endotracheal tube
Supplementary O2 requires..
O2 tank
Flow meter
Ventilators
When cardiopulmonary system is unable to supply adequate oxygen to the tissues, patient may have artificial airway inserted into trachea and then connected to a mechanical ventilator
Ventilator delivers minimum set RR, preset RV, and consistent O2 concentration
Chest Tubes – Anatomy review
Lungs are covered with a double layer serous membrane called Pleura
Outer layer is called parietal pleura and inner layer is called visceral pleura
In-between layers is pleural space where serous fluid is and serves as lubricant
Chest Tubes (Thoracostomy tubes)
When fluid or air accumulates in pleural space, the lung cannot fully expand, and in some cases, may collapse
Chest tubes are inserted through chest wall and drain fluid and reestablish normal intrapleural pressure
Often placed after thoracic surgery or trauma
Chest tubes placement
Placed in pleural space between the ribs (5th and 6th intercostal space)
Tube is connected to collecting canister/chamber which should remain BELOW the site of insertion
Chest drainage systems use gravity and/or suction to remove air/fluid/blood
Urinary Catheters – anatomy review
fxn: filter blood and create urine as a waste by-product
Kidneys, renal pelvis, ureters, bladder, and urethra
Urinary Catheters
Catheterization of urinary bladder is the insertion of a hollow tube through the urethra and into the bladder for removing urine
- Relieve urinary retention
- Provide accurate measurement of urine output
- Empty bladder before, during, after surgery
The French Scale (Fr.) used to de note diameter of catheters
- small number = small catheter
Types of Urinary Catheters – Indwelling catheter (Foley)
Indwelling catheter (Foley)
- most commonly seen in RT patients
- Small tube inserted into urethra an dinto urinary bladder; tip of tube is inflated to anchor tube in bladder, tube is connected to urinary drainage bag
- drainage bag must remain below level of bladder to avoid backflow
- long term or short term
Types of Urinary Catheters – Suprapubic catheters
Suprapubic catheters
- Inserted into bladder through small incision above the pubic area
Types of Urinary Catheters – Texas catheter
Texas catheter
- External condom catheter
Urinary Catheters continued
Urinary tract infection is an infection involving any part of the urinary system
CAUTI = catheter-associated urinary tract infection (75% of UTIs acquired in hospital are catheter associated)
Catheterization should be performed using sterile/aseptic technique
Central Lines
Central venous lines are inserted into a large, central vein (closer to the heart) for variety of issues
Most common insertion site is SUBCLAVIAN VEIN
- other sites include internal jugular and femoral veins
X-rays taken for line placement confirmation
Types of Central Lines – PICC Line
PICC Line (peripherally inserted central catheter)
inserted in vein in the arm and threaded up near the heart Intermediate-length therapy. Allows for continuous access for several weeks to months. No surgery needed. External care and flush regularly.
Types of central lines – Midline catheter
Midline catheter
Placed in vein in arm and threaded towards the heart, but not as far as PICC.
Intermediate length therapy or when regular short-term IV is not advisable or available.
Types of central lines – Tunneled central venous catheter (Hickman Line)
Tunneled central venous catheter (Hickman Line)
surgically placed in large central vein in chest and have multiple separate lumen
Tunneled under skin, but openings to lumens remain outside the body.
Long-term catheter that is good for months to year
Types of central lines – Implantable venous access port (Port-A-Cath)
Implantable venous access port (Port-A-Cath)
Drum-shaped port of plastic, stainless steel, or titanium with silicone septum across the top.
Surgically placed under the skin of the chest or upper arm. Attached catheter extends into a large or central vein
Intended for long-term use
CLABSI
CLABSI = central line-associated bloodstream infection
when bacteria/viruses enter the bloodstream through the central line
Sterile/aseptic technique required when inserting line
IV bags and Lines
IV is placed to give fluid medication, nutrition, or blood into the blood stream directly via peripheral vein (forearm, hand/wrist, feet)
Requires plastic tubing (cannula) that goes into the vein and plastic tubing that connects to bag of fluid
IV bag should always be hung ABOVE patient to prevent backflow and ensure constant flow rate
Feeding Tubes
medical devices used to provide nutrition to people who are unable to swallow safely or need nutritional supplementation
Factors and considerations:
- GI tract function and accessibility
- expected length of time
- planned surgical intervention
- patient and family preferences
- Pre-existing medical conditions
- plan for discharge
Types of feeding tubes – Nasogastric tube (NG tube)
Nasogastric tube (NG tube)
Inserted through the nose and down the back of the throat through the esophagus and into the stomach
- remove fluids and gas
- administer nutrition or medication
- prevent pressure on surgery site
Types of feeding tubes – Dobhoff tube
Dobhoff tube
special type of NG tube that has a smaller bore and is more flexible
Types of feeding tubes – PEG tube (G-tube)
PEG tube (G-tube)
- Long-term feeing
- Percutaneous endoscopic gastrotomy tube
- inserted into the stomach
- administer nutrition and medications
Types of feeding tubes – Jejunostomy tube (J-tube)
Jejunostomy tube (J-tube)
- long-term feeding
- inserted into jejunum
Ostomies
Ostomy = surgery to create opening (stoma) from an area inside the body to the outside (usually to allow the elimination of bodily waste)
End portion of the colon, small intestine, or ureter is brought to the outside of the skin
No feeling in the stoma
Performed when person does not have or has lost normal body function of the bowel of bladder
- birth defect
- disease
- injury
Tracheostomy
Artificial opening into the trachea (windpipe) that provides an alternative airway for breathing that bypasses the upper airway
May be temporary or permanent
Disadvantages include:
- require some suctioning
- risk of infection
- inability to vocalize
- loss of taste and smell
- possible displacement of tracheostomy tube
- loss of control
Decannulation = removal of tracheostomy tube
Tissue drains
Device that promotes drainage of fluid, blood, or puss from a wound and are typically inserted after surgery to avoid body fluid accumulation and infection
drains may be hooked to wall suction, portable suction device, or may drain by gravity
- active = maintained under suction
- passive = no suction
Types of Tissue Drains – Jackson-Pratt drain
Jackson-Pratt drain
used to remove fluids that build up in an area of the body after surgery
Common for abdominal, breast, and thoracic surgery
Bulb shaped device connected to a tube that is inserted into the body
Negative pressure vacuum
Types of tissue drains – Hemovac drain
Hemovac drain
fine tube with many holes at the end and attached to an evacuated bottle which provides suction
Types of tissue drains – Penrose drain
Penrose drain
soft, flexible device that pulls fluid out of wound, typically used to keep fluid from collecting under an incision
Cardiac monitoring
Electrocardiogram (ECG or EKG) is on the the simplest and fastest tests used to evaluate the heart through recording of heart’s electrical activity
Electrodes placed at specific location on the chest
EKG interpretation:
