Tubes and lines

Question 1

Feeding tubes

Answer 1

• Nasogastric, nasoduodenal, and nasojejunal
• PEG tube (percutaneous endoscopic gastrostomy) or PEJ tube (percutaneous endoscopic jejunoscopy)
• Total parenteral nutrition

Question 2

Urine Drainage tubes

Answer 2

• Foley catheter
• Suprapubic/Nephrostomy
• Texas (condom) catheter applied externally to a drainage bag
• External female catheter
• Implications for PT: If kinked, unkink. If pulled out of position or pulled out, notify nursing. Maintain below level of insertion to prevent backflow or briefly occlude tubing to prevent backflow when repositioning.

Question 3

Foley catheter

Answer 3

Foley catheter -can be tube into the urethra to bladder

Question 4

Suprapubic/Nephrostomy

Answer 4

• surgically inserted at the lower abdominal (suprapubic) or low back (nephrostomy)area

Question 5

Texas (condom) catheter

Answer 5

applied externally
goes to a drainage bag

Question 6

External female catheter

Answer 6

wicks moisture into a collection container

Question 7

Feces collection types nd implications for PT

Answer 7

• rectal catheter
• ostomies (colostomy/ileostomy)
• Implications for PT: Avoid tension on the bag. The bag must be changed immediately if a leak develops to protect the stoma and adjacent skin. Be careful with gait belts/compression

Question 8

Rectal catheter

Answer 8

for collection of feces. You can assume entry point.

Question 9

Ostomies (colostomy/ileostomy)

Answer 9

attached to an opening in the large intestine (stoma- which means “little mouth” for excretion/collection of feces.

Question 10

Post surgical drain
- types and their implications for PT

Answer 10

• continuous suction to remove drainage from an operative site. Many types but these are 2 common ones.
• Hemovac – Self-contained post-op suction device
• Jackson Pratt – Bulb shaped
• Implications for PT: If surgical drain is accidentally removed, place immediate pressure over site and call for help. Usually not a problem and is removed a few days post surgery

Question 11

Chest tubes/pleurovac
plus implications for PT

Answer 11

• Implications for PT: Chest tube collection system MUST remain upright and below the insertion site.
• Avoid disruption, disconnection, or occlusion.
• Avoid kinking or obstructing tubing. Patient can still perform positioning, coughing and mobility activities.
• Monitor vital signs especially respiratory status – RR, respiratory pattern, lung sounds, oxygen saturation

Question 12

Sequential pressure devices

Answer 12

• Worn externally on LE’s to allow for improved venous return, DVT prevention
• May be removed for mobility, usually discontinued when patient is regularly OOB and ambulatory

Question 13

Cardiovascular devices that can connect to a monitor

Answer 13

• Cardiac leads to a cardiac monitor, or temporary pacemaker.
• Temperature Monitoring: May be done continually in those who are unable to have an oral temp taken. Usually attached in the nose or rectally connected by the Foley catheter.
• BP Cuff and Pulse ox
• Pulse ox attached to finger, toe or ear.
• Arterial Lines/Central Lines

Question 14

Intravenous lines

Answer 14

• are thin flexible catheters usually inserted into forearm or hand, but any peripheral vessel can be used.
• Used for blood work, administer meds/fluids.
• Usually not used for monitoring.

Question 15

Arterial lines

Answer 15

• Inserted by a physician or specialized nurse. They are indicated in the critically ill patient, inserted into an artery and connected to a transducer to allow for direct blood pressure monitoring. Used for administering vasoactive medications, monitoring arterial blood gases (ABG’s), monitoring arterial blood pressures,
• Mean arterial pressure (MAP). Usually inserted in brachial, radial, or femoral artery and usually changed every 4-5 days.
• Mean Arterial Pressure (MAP) – provides an average of the systolic and diastolic pressures on the circulatory system. Usually slightly less than the average because the diastolic phase lasts longer than systolic phase. Acceptable MAP between 70 and 110mmHG. A minimum of 60mmHg is needed to provide enough blood to nourish the coronary arteries, brain and vital organs. When MAP falls below 60 for a considerable amount of time, organs may become deprived of the oxygen they need.

Question 16

Implications for PT with intravenous lines

Answer 16

• Limit ROM near the site of insertion, do not kink or bend lines. Avoid disruption, disconnection, or occlusion. Can still perform positioning, ROM as able, and mobility activities. Consult nursing for safe limits with any critically ill patient.
• Emergency: A-lines present a hemorrhage risk if accidentally removed, apply pressure and call for help! If line becomes disconnected from bag or bottle, close stopcock or pinch off, get help.

Question 17

PICC line

Answer 17

• is a central line inserted via a peripheral vein such as the basilic, cephalic or brachial vein for prolonged placement of a central line. Long term use for meds (chemo) or monitoring.

Question 18

Tunneled catheter

Answer 18

• a central line that passes under the skin before entering the a jugular or subclavian vein before being threaded to the vena cava.
• More secure, less visable. Usually for Long term chemotherapy or dialysis

Question 19

Implanted intravascular port

Answer 19

• catheter or reservoir fully implanted under the skin within a large vein for repeated or long term medication administration or blood sampling. You would feel or see a hard object under the skin.
• This is the port and serves as the location that the IV would be attached to. This avoids repeated venipuncture.
• Usually for Long term chemotherapy or dialysis
  ***triple lumen catheter line, meaning there are 3 points of entry with one line inserted into the vessel. Each line can be designated for a specific med or purpose
• Complications: Remember this line is called a CENTRAL LINE because it is directed to the vena cava, very close to the heart. Complications are rare but increased risk of infection, sepsis, thrombus is present. If accidentally dislodged or removed, hemorrhage, life threatening arrhythmias, air embolism could occur.

Question 20

Implications for PT with central lines

Answer 20

• Consult nursing for safe limits with critically ill patients.
• Avoid BP cuff on this extremity.
• Tunneled catheter and port are more secure than a PICC.
• Movement restrictions are dependent on location

Question 21

Swan-Ganz catheter

Answer 21

• Allows hemodynamic monitoring in critically ill patients.
• Inserted by a physician, introduced via a large venous access point (jugular, subclavian, femoral),
• through the right side of the heart, through the pulmonary valve and into the pulmonary artery.
• Allows for accurate and continuous measurement of flow, pressure and oxygenation saturation

Question 22

Implications for PT with Swan-ganz catheter

Answer 22

• Limit ROM near the site of insertion,
• do not kink or bend lines.
• Avoid disruption, disconnection, or occlusion.
• Can still perform positioning, ROM as able, and mobility activities.
• Consult nursing for safe limits with any critically ill patient

Question 23

Artificial airways

Answer 23

• Oropharyngeal airway or bite guard
• nasotracheal tube
• endotracheal tube
• tracheostomy tube

Question 24

Oropharyngeal airway

Answer 24

• moves the tongue anteriorly, opening the airway, limits biting of the tongue and endotracheal tubes. Used to keep tongue from blocking airway

Question 25

Nasotracheal tube

Answer 25

• Through the nose, used for maxillofacial surgery or those with limited mouth opening. Connects nose to upper airway.. Patient may not be able to speak

Question 26

endotracheal tube

Answer 26

• through the mouth,
• used to couple patient to a ventilator, to maintain a patent airway, aid in pulmonary toilet, minimize aspiration.
• Usually short term use.
• Functions may be to assist with airway protection, improved gas exchange, suctioning. Patient may not be able to speak

Question 27

tracheostomy tube

Answer 27

• directly into the trachea.
• Inserted between the 2nd and 3rd cartilaginous rings, inferior to the vocal cords;
• used when long term ventilator assistance is required or unable to use endotracheal tube due to facial trauma, intubation failure.
• Functions to maintain long term oxygenation/ventilation, pulmonary suctioning

Question 28

Implications for PT with artificial airways

Answer 28

• Do NOT disconnect or kink tubing, ensure devices are secure.
• Care must be taken in cervical ROM, bed mobility, and transfers.
• Patients can be mobilized with appropriate care
• Emergency: If endotracheal tube or tracheostomy tube is accidently removed, re-establish airway and ventilate, Call for help.
• If ventilator tubing becomes kinked or disconnected, reconnect or unkink.

Question 29

Oxygen masks

Answer 29

Nasal Cannula, aerosol mask, rebreather mask – used to provide oxygen

Question 30

Ventilator

Answer 30

• Machine-assisted device. Different modes provide different amounts of assistance.
• Implications for PT: Activity may cause alarms to sound. May perform OOB activities with assist and within limits of tubing. Requires a team approach.
• Emergency: If endotracheal tube or tracheostomy tube is accidently removed, re-establish airway and ventilate, Call for help.

Question 31

Airway suctioning devices

Answer 31

• may be found at the bedside for intermittent suctioning of oral and pulmonary secretions.
• Implications for PT: Patient is often more comfortable if suctioned prior to therapy or mobility. Some PT’s are trained to suction. If not trained, call nursing staff to suction

Question 32

A bag valve mask

Answer 32

• sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or “self-inflating bag”, is a hand-held device commonly used to provide positive pressure ventilationto patients who are not breathing or not breathing adequately.