Tubes and Lines Flashcards
1
Q
Arterial lines found in which 3 arteries
A
brachial, radial, femoral
2
Q
normal readings for arterial lines
A
systolic = 80-180 diastolic = 40-110
3
Q
two most cumbersome arterial lines for PT’s
A
radial and femoral
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!
5
Q
another name for port
A
lumen
6
Q
Central venous catheter (CVP) inserted via which 3 veins?
A
subclavian, internal jugular, or femoral vein
7
Q
Central venous catheter (CVP) measures what
A
measures right aterial pressure by entering the superior vena cava
8
Q
normal values for Central venous catheter (CVP)
A
0-6
9
Q
CVP provides info about what
A
the body’s volume status and right ventricular function
10
Q
name of long term CVP
A
Hickman-Groshong
only has 1 port, whereas short term CVP’s can have 2 or 3
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
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
13
Q
Pulmonary artery catheter is also called?
A
Swan Ganz
14
Q
Pulmonary artery catheter where does it go?
A
passed through right side of heart into pulmonary vesel
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
16
Q
PAC approximates what value?
A
left ventricular end diastolic pressure - preload
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
18
Q
function of PAC
A
administers fluids and assesses fluid balance
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
20
Q
how long is PAC line usually left in?
A
for 24-48 hrs following surgery
21
Q
function of a PICC line
A
provides an alternate means of vascular access
22
Q
PICC stands for
A
peripherally inserted central catheter
23
Q
PICC line goes where?
A
from antecubital fossa to lower 1/3 of superior vena cava – almost enters right atrium
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
25
is the PICC line sutured in?
yes
26
Midline catheter
- 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)
27
Intravenous (IV) catheters use
- 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
28
TPN
total parenteral nutrition for those without a functioning stomach due to disease, meds etc
29
which lines need an xray?
- any line that enters the heart
- not IV catheters
- PICC, midline catheter, hickman, swan ganz, central venous lines
30
What do you avoid with IV catheters?
don't take BP on side of IV
31
this type of IV is the only one truly used for short term only
Peripheral IV
32
therapist implications of peripheral IVs
- don't take BP in that extremity
| - don't do repetitive ROM w/ elbow if IV in antecubital fossa -- can rupture
33
ICP (intracranial pressure monitoring) reflects the relationship between what 3 structures?
brain, CSF, and cerebral circulation
34
normal value for ICP
0-15 mmHg
| over 20 is critical. cannot work with pt if value is 20+
35
ICP normal waveform has how many peaks
3
36
Codman drain (ICP)
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
37
ICP physician order
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
38
Function of camino bolt
does not drain CSF. only measures pressure
39
Camino bolt pts vs ICP codman drain pts -- who can we work with?
CANNOT work with camino bolt pts. can work with codman bolt pt's as long as their value is not over 20
40
types of exercises you can do with ICP pt's without doctors order
PROM or AAROM in supine in the bed
41
CPP stands for
cerebral perfusion pressure (type of intracranial pressure monitoring)
42
CPP is a value that is calculated from which two numbers/values?
MAP and intracranial pressure
| MAP - ICP = CPP
43
normal CPP value
60-150 mmHg
44
T/F: if ICP value is abnormal, CPP value will also be abnormal and you will NOT work with the pt
TRUE!
45
IABP stands for
intraaortic balloon pump
46
IABP does what
asissts with circulation of blood through the body and reduces the work of the heart
47
how does the IABP work? (balloon)
- helium balloon inflates during diastole and deflates in systole to help pump blood to the body
48
when is an IABP used?
before or after heart surgery and if a pt is in acute heart failure
49
can we work with IABP pt's?
NO! too fragile
50
if we do work with IABP pt's what are the only things we can really do with them?
- log roll only
- no hip flexion on the side the apparatus is in (goes thru femoral)
- these pt's are on strict bedrest
51
Pacemakers are used when
for chronic dysrhthmias
52
AICD (defibrillators) are used for which pts
those with life threatening arrhythmias (3rd degree AV block)
53
temporary pacemakers are used when? do we work with them?
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
Therapist implications for pacemakers/defibrilators
- 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
what is a VAD and what does it do
- surgically implanted mechanical device that helps the heart pump blood
- used for pt's with advanced heart failure
56
Therapist implications for VAD
- 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
How do you measure exercise intensity with VAD pt's?
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
Chest tubes are used for which 4 conditions
pneumothorax, hemothorax, empyema, pleural effusion
59
chest tubes can drain in which 3 ways
1) naturally
2) with water seal which produces very light suction
3) suction hooked up to wall - for more advanced pleural effusions etc
60
what do you do if you tip the chest tube over?
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
chest tubes: doctors orders
can ask for order for portable suction so that you can ambulate pt. Doctor order is needed to disconnect suction.
62
chest tubes" therapist implications
- 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
5 types of feeding tubes
1. nonvented single and vented double lumen tube
2. nasogastric tube
3. PEG
4. gastrostomy
5. jejunostomy
64
nonvented single and vented double lumen tubes
preferred for enteral feedings
65
NG tube
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
PEG stands for
percutaneous endoscopic gastrostomy
67
PEG used when
long term
constant pump feed
can be turned off for PT
inserted into abdominal wall and then goes into intestines
68
Gastrostomy tube
easy access for meds
MS, end stage ALS
bolus feed
69
Jejunostomy
- reduced risk of aspriation
| - bolus feeding
70
gastric bolus feedings wait how long before putting head flat
15-20 min
71
continuous feed = wait time?
no wait time (NG and PEG are constant)
72
PT implications for feeding tubes
turn tube off when pt below 30 deg and restart when pt above 30 (aspiration risk)
73
Jackson Pratt Drain
- 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
Hemovac drain
- 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
3 types of dialysis
1. peritoneal
2. hemodialysis
3. hemofiltration
76
what is dialysis
process fo separating elements in a solution by diffusion across semipermeable membrane
- pt will be tired; cannot work with them after dialysis
77
Hemodialysis
- 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
this type of dialysis lasts 3-5 hrs and involves removing the blood, filtering it and putting it back (diabetes pts)
hemodialysis
79
4 types of peritoneal dialysis
1. Intermittent (IPD)
2. continuous ambulatory (CAPD)
3. cyclic continuous (CCPD)
4. Equilibrium (EPD)
80
peritoneal dialysis
less common
| involves 2 bags: 1 in and 1 out
81
Intermittent peritoneal dialysis
- dialysate infused rapidly, dwells, and drained
- cycle lasts 10 min
- effects last 8-48hrs
- occur 3-7 days per week
82
Continuous Ambulatory peritoneal dialysis
- infusion 10 min
- dwell 4-8 hrs
- drain 10 min
lasts 3-4 times per day and 1 night
83
advantage of Continuous Ambulatory peritoneal dialysis
closely approximates normal fxn of kidneys
homeostasis is maintained
no special equipment needed
84
peritoneal dialysis is used for which pts
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
Cyclic Continuous peritoneal dialysis
- combo of IPD and CAPD
- last 3-4 times per night lasting 8 hrs
decreases chance of infection!!
86
Equilibrium PD
continous peritoneal eqiulibrium for nonambulatory pts
| given by nurses (trained caregivers)
87
complications of PD
- 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
Signs that electrolytes are off
CONFUSION!
| - dizzy, decreased urine output
89
PT implications for dialysis
- 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
Hemofiltration dialysis
- used in fragile pts in ICU only
- dilutes blood, therefore decreasing blood serum
- used in conjunction w/ hemodilaysis often
- 4 kinds
91
4 kinds of hemofiltration (organized based on disease process)
1. CAVHD
2. CVVH
3. CVVHD
4. CVVHDF
92
CAVHD - continuous arteriovenous hemofiltration
- subclavian, jugular, or femoral vein
93
CVVH - continuous veno venous hemofiltration
- removes mid sized molecules (inflammatory cytokines)
- improves sepsis and volume overloaded pts
- replacement electrolyte solution needed to maintain hemodynamic stability
94
CVVHD - continuous veno venous hemodialysis
contiuous diffuse dialysis
95
CVVHDF!!!!!! continuous veno venous hemodiafiltration
- most popular in ICU
- combines convective and diffuse dialysis
- small and mid sized molecules are cleared
- replacement fluids required after trtmt
96
PT implcations for hemodialysis
- 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
Urinary and REctal Catheters
- foley cath = urinary
| - foley held in with bulb
98
PT implications with urinary and rectal catheters
- 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
don't work with these pt's (3)
pulmonary artery cath (swan ganz), IABP (balloon pump for heart), and camino bolt (ICP)
