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Semester 5 PMCP Exam 2 > Tubes and Lines > Flashcards

Tubes and Lines Flashcards

1
Q

Arterial lines found in which 3 arteries

A

brachial, radial, femoral

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2
Q

normal readings for arterial lines

A 
systolic = 80-180
diastolic = 40-110
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3
Q

two most cumbersome arterial lines for PT’s

A

radial and femoral

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4
Q

What to avoid/be cautious of with arterial lines

A
  • avoid kinking line
  • turn only 90 deg in sidelying
  • careful ROM! avoid wrist ROM with radial, caution with elbow ROM w/ brachial, and do not go past 45 deg hip flexion with femoral!
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5
Q

another name for port

A

lumen

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6
Q

Central venous catheter (CVP) inserted via which 3 veins?

A

subclavian, internal jugular, or femoral vein

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7
Q

Central venous catheter (CVP) measures what

A

measures right aterial pressure by entering the superior vena cava

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8
Q

normal values for Central venous catheter (CVP)

A

0-6

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9
Q

CVP provides info about what

A

the body’s volume status and right ventricular function

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10
Q

name of long term CVP

A

Hickman-Groshong

only has 1 port, whereas short term CVP’s can have 2 or 3

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11
Q

Therapist procautions for central venous catheter (CVP)

A

45 deg hip flexion max

don’t roll pt to side the catheter is on because it can advance the catheter and cause PVCs

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12
Q

neck ROM with CVP in jugular vein

A

do ROM of the neck even though it may be uncomfortable for the pt. When not doing ROM ex, make sure pt keeps head at midline because they may have a tendency to lean head towards the line for comfort

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13
Q

Pulmonary artery catheter is also called?

A

Swan Ganz

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14
Q

Pulmonary artery catheter where does it go?

A

passed through right side of heart into pulmonary vesel

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15
Q

pulmonary artery catheter provides you with what info?

A

provides immediate profile of cardiac fxn by measuring pulmonary artery pressure and cardiac output

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16
Q

PAC approximates what value?

A

left ventricular end diastolic pressure - preload

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17
Q

normal range for PAC

A

5-15mmHg

if > 12 pt should NOT be placed in a horizontal position because venous return will increase

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18
Q

function of PAC

A

administers fluids and assesses fluid balance

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19
Q

Color of PAC? Do we work with them?

A

yellow! we do NOT work with these pt’s. they are usually on bed rest due to risk of pulmonary/jugular vein thrombosis, PA rupture, sepsis, arrthymias, and hemorrhage

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20
Q

how long is PAC line usually left in?

A

for 24-48 hrs following surgery

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21
Q

function of a PICC line

A

provides an alternate means of vascular access

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22
Q

PICC stands for

A

peripherally inserted central catheter

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23
Q

PICC line goes where?

A

from antecubital fossa to lower 1/3 of superior vena cava – almost enters right atrium

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24
Q

avoid which motions with pt’s with PICC line

A

avoid shoulder or elbow flexion past 90 deg. can do once if you need to measure it, but do not do repetitively or you can advance the line into the RA and cause arrthymias

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25
Q

is the PICC line sutured in?

A

yes

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26
Q

Midline catheter

A
  • looks exactly like a PICC line but is NOT sutured in
  • usually in antecubital fossa
  • same restrictions as PICC line (avoid shoulder/elbow flexion past 90 deg)
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27
Q

Intravenous (IV) catheters use

A
  • provde short term access for blood products, IV fluids, and meds
  • long term access for antibiotics, TPN, dialysis or chemo
  • monitor CVP, RAP, PAP, temp
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28
Q

TPN

A

total parenteral nutrition for those without a functioning stomach due to disease, meds etc

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29
Q

which lines need an xray?

A
  • any line that enters the heart
  • not IV catheters
  • PICC, midline catheter, hickman, swan ganz, central venous lines
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30
Q

What do you avoid with IV catheters?

A

don’t take BP on side of IV

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31
Q

this type of IV is the only one truly used for short term only

A

Peripheral IV

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32
Q

therapist implications of peripheral IVs

A
  • don’t take BP in that extremity

- don’t do repetitive ROM w/ elbow if IV in antecubital fossa – can rupture

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33
Q

ICP (intracranial pressure monitoring) reflects the relationship between what 3 structures?

A

brain, CSF, and cerebral circulation

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34
Q

normal value for ICP

A

0-15 mmHg

over 20 is critical. cannot work with pt if value is 20+

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35
Q

ICP normal waveform has how many peaks

A

3

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36
Q

Codman drain (ICP)

A

drain is leveled with inner ear, so if you get pt up must clamp drain (so CSF does not leak out) and then get nurse to re-level drain with new pt position

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37
Q

ICP physician order

A

cannot get pt out of bed or raise head of bed if you do not have order from doc. you can work on arms or legs in the bed though w/o an order

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38
Q

Function of camino bolt

A

does not drain CSF. only measures pressure

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39
Q

Camino bolt pts vs ICP codman drain pts – who can we work with?

A

CANNOT work with camino bolt pts. can work with codman bolt pt’s as long as their value is not over 20

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40
Q

types of exercises you can do with ICP pt’s without doctors order

A

PROM or AAROM in supine in the bed

41
Q

CPP stands for

A

cerebral perfusion pressure (type of intracranial pressure monitoring)

42
Q

CPP is a value that is calculated from which two numbers/values?

A

MAP and intracranial pressure

MAP - ICP = CPP

43
Q

normal CPP value

A

60-150 mmHg

44
Q

T/F: if ICP value is abnormal, CPP value will also be abnormal and you will NOT work with the pt

A

TRUE!

45
Q

IABP stands for

A

intraaortic balloon pump

46
Q

IABP does what

A

asissts with circulation of blood through the body and reduces the work of the heart

47
Q

how does the IABP work? (balloon)

A
  • helium balloon inflates during diastole and deflates in systole to help pump blood to the body
48
Q

when is an IABP used?

A

before or after heart surgery and if a pt is in acute heart failure

49
Q

can we work with IABP pt’s?

A

NO! too fragile

50
Q

if we do work with IABP pt’s what are the only things we can really do with them?

A
  • log roll only
  • no hip flexion on the side the apparatus is in (goes thru femoral)
  • these pt’s are on strict bedrest
51
Q

Pacemakers are used when

A

for chronic dysrhthmias

52
Q

AICD (defibrillators) are used for which pts

A

those with life threatening arrhythmias (3rd degree AV block)

53
Q

temporary pacemakers are used when? do we work with them?

A

used after heart surgery. kept in 24-48 hrs (or turned off after that time)
we cannot work with them while the pacemaker is on. can work with them if it is off

54
Q

Therapist implications for pacemakers/defibrilators

A
  • no shoulder flexion past 90 deg
  • don’t take BP on side of pacemaker
  • can exercise these pt’s!
  • avoid lifting more than 10lbs for first 6wks
  • no isometrics or therabands
55
Q

what is a VAD and what does it do

A
  • surgically implanted mechanical device that helps the heart pump blood
  • used for pt’s with advanced heart failure
56
Q

Therapist implications for VAD

A
  • warm up and cool down are VIP b/c VAD works at a set rate
  • keep plugged in
  • no arm exercises above 90 deg
  • progressive ambulation (don’t push too hard too fast)
  • avoid simultaneous bilat shoulder flexion/abduction > 90 deg
57
Q

How do you measure exercise intensity with VAD pt’s?

A

RPE or pulsitory index (flow going through the device - will be low med or high)
cannot use pulse or BP b/c can’t feel pulse and BP won’t change with exercise

58
Q

Chest tubes are used for which 4 conditions

A

pneumothorax, hemothorax, empyema, pleural effusion

59
Q

chest tubes can drain in which 3 ways

A

1) naturally
2) with water seal which produces very light suction
3) suction hooked up to wall - for more advanced pleural effusions etc

60
Q

what do you do if you tip the chest tube over?

A

tell nurse b/c contents will be mixed
keep chest tube below level of body insertion area or drainage will flow back into body
document if more fluid comes out when pt sits up or stands

61
Q

chest tubes: doctors orders

A

can ask for order for portable suction so that you can ambulate pt. Doctor order is needed to disconnect suction.

62
Q

chest tubes” therapist implications

A
  • can exercise these pts if you have doctors order to disconnect suction
  • can do UE ROM! and should b/c pt may want to avoid this b/c it’s uncomfortable but need to do.
63
Q

5 types of feeding tubes

A
  1. nonvented single and vented double lumen tube
  2. nasogastric tube
  3. PEG
  4. gastrostomy
  5. jejunostomy
64
Q

nonvented single and vented double lumen tubes

A

preferred for enteral feedings

65
Q

NG tube

A

used when pt needs nutrition for longer than 3-4 wks
constant pump feed
can be disconnected so pt can move (walk for PT)
xray needed
pay attn to #’s

66
Q

PEG stands for

A

percutaneous endoscopic gastrostomy

67
Q

PEG used when

A

long term
constant pump feed
can be turned off for PT
inserted into abdominal wall and then goes into intestines

68
Q

Gastrostomy tube

A

easy access for meds
MS, end stage ALS
bolus feed

69
Q

Jejunostomy

A
  • reduced risk of aspriation

- bolus feeding

70
Q

gastric bolus feedings wait how long before putting head flat

A

15-20 min

71
Q

continuous feed = wait time?

A

no wait time (NG and PEG are constant)

72
Q

PT implications for feeding tubes

A

turn tube off when pt below 30 deg and restart when pt above 30 (aspiration risk)

73
Q

Jackson Pratt Drain

A
  • self contained low pressure drain with compressed bulb that expands slowly, creating suction
  • used to eliminate air/blood from abdominal cavity or drain blood from skull (CSF)
  • used after abdominal surgeries
  • will be hanging. tape to person or put in pocket while up and walking
74
Q

Hemovac drain

A
  • low pressure drain
  • decompressed and then expands slowly to create suction
  • used after TKA or THA to drain blood
  • has a clip attached to clip to pt while walking
75
Q

3 types of dialysis

A
  1. peritoneal
  2. hemodialysis
  3. hemofiltration
76
Q

what is dialysis

A

process fo separating elements in a solution by diffusion across semipermeable membrane
- pt will be tired; cannot work with them after dialysis

77
Q

Hemodialysis

A
  • man made membrane clears waste from blood, rstores electrolytes
  • catheter inserted into internaljugular or subclavian
  • lasts 3-5 hrs
  • blood removed filtered and reinserted
78
Q

this type of dialysis lasts 3-5 hrs and involves removing the blood, filtering it and putting it back (diabetes pts)

A

hemodialysis

79
Q

4 types of peritoneal dialysis

A
  1. Intermittent (IPD)
  2. continuous ambulatory (CAPD)
  3. cyclic continuous (CCPD)
  4. Equilibrium (EPD)
80
Q

peritoneal dialysis

A

less common

involves 2 bags: 1 in and 1 out

81
Q

Intermittent peritoneal dialysis

A
  • dialysate infused rapidly, dwells, and drained
  • cycle lasts 10 min
  • effects last 8-48hrs
  • occur 3-7 days per week
82
Q

Continuous Ambulatory peritoneal dialysis

A
  • infusion 10 min
  • dwell 4-8 hrs
  • drain 10 min
    lasts 3-4 times per day and 1 night
83
Q

advantage of Continuous Ambulatory peritoneal dialysis

A

closely approximates normal fxn of kidneys
homeostasis is maintained
no special equipment needed

84
Q

peritoneal dialysis is used for which pts

A

those who can’t tolerate shifts in BP from hemodialysis

dialysis catheter inserted into perineum and has a double cuff that sits in abdominal wall

85
Q

Cyclic Continuous peritoneal dialysis

A
  • combo of IPD and CAPD
  • last 3-4 times per night lasting 8 hrs
    decreases chance of infection!!
86
Q

Equilibrium PD

A

continous peritoneal eqiulibrium for nonambulatory pts

given by nurses (trained caregivers)

87
Q

complications of PD

A
  • HTN or hypotension due to fluid shift
  • infection
  • mechanical issue
  • arrythmias due to electrolyte imbalance
  • pleural effusion from fluid shift
  • pneumonia
  • metabolic issues
  • seizures, hypothyroidism
88
Q

Signs that electrolytes are off

A

CONFUSION!

- dizzy, decreased urine output

89
Q

PT implications for dialysis

A
  • hip flexion not past 45 deg if femoral port
  • pt = fatigue, dizzy, dehydrated, electrolyte imbalance
  • swelling, bone cysts, muscle cramps
  • elevate bed to allow for drainage
90
Q

Hemofiltration dialysis

A
  • used in fragile pts in ICU only
  • dilutes blood, therefore decreasing blood serum
  • used in conjunction w/ hemodilaysis often
  • 4 kinds
91
Q

4 kinds of hemofiltration (organized based on disease process)

A
  1. CAVHD
  2. CVVH
  3. CVVHD
  4. CVVHDF
92
Q

CAVHD - continuous arteriovenous hemofiltration

A
  • subclavian, jugular, or femoral vein
93
Q

CVVH - continuous veno venous hemofiltration

A
  • removes mid sized molecules (inflammatory cytokines)
  • improves sepsis and volume overloaded pts
  • replacement electrolyte solution needed to maintain hemodynamic stability
94
Q

CVVHD - continuous veno venous hemodialysis

A

contiuous diffuse dialysis

95
Q

CVVHDF!!!!!! continuous veno venous hemodiafiltration

A
  • most popular in ICU
  • combines convective and diffuse dialysis
  • small and mid sized molecules are cleared
  • replacement fluids required after trtmt
96
Q

PT implcations for hemodialysis

A
  • don’t bump the bed! machine will shut off if it sense movement
  • can work with these pts, just be careful
  • don’t get them out of bed
  • PROM, maybe AAROM
    femoral area: only ankle pumps that side
97
Q

Urinary and REctal Catheters

A
  • foley cath = urinary

- foley held in with bulb

98
Q

PT implications with urinary and rectal catheters

A
  • don’t hold bag or line above insertion site
  • don’t dislodge tube
  • clip catheter tube to clothes
  • don’t sheer tube on surface pt is on when moving them (rectal tube) – roll them all the way to their side or turn with sheet to get to side of bed – no movement of butt on sheet or it will fall out
99
Q

don’t work with these pt’s (3)

A

pulmonary artery cath (swan ganz), IABP (balloon pump for heart), and camino bolt (ICP)

Semester 5 PMCP Exam 2 (3 decks)

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