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Semester 5 PMCP Exam 2 > Tubes and Lines > Flashcards

Tubes and Lines Flashcards

1
Q

Arterial lines usually placed where

A

femoral, radial, or brachial arteries

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2
Q

Arterial line permits what

A

repetitive arterial blood samples

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3
Q

Arterial lines measure what

A

arterial blood pressure

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4
Q

Most accurate readings from arterial lines are in what position

A

limb straight and level with the heart

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5
Q

Normal for systolic and diastolic for arterial line readings

A 
Sys = 80 to 180
Dias = 40-110
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6
Q

What to keep in mind with femoral arterial line (ROM restriction)

A

no hip flexion past 45 degrees with rigid one

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7
Q

Therapist implications - arterial line

A

Avoid kinking off
Turn only 90 deg in SL
Careful ROM to prox joints

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8
Q

Central venous catheter - inserted most commonly through what

A

subclavian vein
internal jugular
femoral vein

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9
Q

Tip of the central venous catheter enters what

A

the SVC

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10
Q

Central venous catheter measures what

Provides info about what

A

right arterial pressure

About the body’s volume status and RV function

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11
Q

Normal central venous catheter findings

A

0 to 6

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12
Q

What are long term central venous catheters called

A

Hickman Groshong catheters

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13
Q

Therapist implications with central venous catheter

A

Dont roll patient to side catheter is on - might cause PVC

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14
Q

Triple lumen

A

IV lines that emerge into one main vein

Provides access to pt for large dose of meds, fluids, and blood for parenteral nutrition

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15
Q

Pulmonary artery catheter AKA

A

Swan Ganz

IS YELLOW!

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16
Q

Pulmonary artery catheter is passed through where

A

the right side of the heart into a pulmonary branched vessel

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17
Q

Pulmonary artery catheter provides what

A

an immediate profile of cardiac function by measuring pulmonary artery pressure and CO

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18
Q

Pulmonary artery catheter approximates

A

left ventricular end - diastolic pressure - preload

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19
Q

Normal measure for pulmonary artery catheter

A

5-15 mmHg

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20
Q

Precautions with measure of pulmonary artery catheter greater than 12mmHg

A

do not place them in a horizontal position because venous return will increase

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21
Q

Therapist implications with PA catheter - these patients are frequently

A

restricted to bed rest because of risk of pulmonary thrombosis, jugular vein thrombosis, PA rupture, hemorrhage, sepsis and arrhythmia

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22
Q

Peripherally Inserted Central Catheter (PICC) provides what

A

alternate means of vascular access

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23
Q

PICC - use is long or short term?

A

Can be used short or long term

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24
Q

PICC - can it be used at home

A

Yes, appropriate for home IV therapy

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25
Q

PICC - catheter is inserted by

A

venipuncture of the basilic, medial cubital or cephalic vein, at or above the antecubital space

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26
Q

PICC - tip advances to where

A

lower 1/3 of SVC

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27
Q

How can you tell if patient has a PICC - description

A

Tiny - has blue of white butterfly taped down

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28
Q

Therapist implications with PICC (ROM)

A

Do not flex shoulder or elbow more than 90
Could cause arrhythmia
Avoid dislodging

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29
Q

Intravenous catheters are used for what short term

A

to provide short term access into the body for blood products, IV fluids, and meds

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30
Q

Intravenous catheters are used for what long term

A

access for IV antibiotics, total parenteral nutrition, dialysis or chemo

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31
Q

Intravenous catheters will monitor what

A

central venous pressure or right atrial pressure, pulmonary artery pressure, wedge pressure, and temperature

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32
Q

Midline catheter - description

A

looks like PICC line but is not sutured in like the PICC line is

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33
Q

Midline catheter is usually located

A

in the antecubital fossa

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34
Q

Intravenous catheter - methods of placement - PICC, midline, IV lines placed by who

A

Nursing or IV team

PICC and midline are xrayed after

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35
Q

Intravenous catheter - methods of placement - Hickman, Swan Ganz, and central venous lines are usually placed by who

A

physicians at bedside, stitched into place and then x-rayed after placement

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36
Q

Therapist implications with IV catheter

A

No BP in that extremity

Do not dislodge

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37
Q

Peripheral IVs - long or short term use

A

short term use 24-48 hours

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38
Q

Peripheral IVs - placed where

A

anywhere from hand to upper arm to feet and thighs

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39
Q

Therapist implications for peripheral IV

A

Do not dislodge
No BP in that extremity
Cautious with elbow flexion

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40
Q

Intravenous pumps - common alarms

A

Low battery
Occlusion
Air in line
Infusion complete

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41
Q

What to do with lwo battery alarm

A

plug into wall outlet

Loses all settings if battery dies

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42
Q

What to do with occlusion alarm

A

Adjust the line and stop mvmnt to stop occlusion

Push appropriate channel and then push start

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43
Q

What to do with air in line alarm

A

contact the nurse

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44
Q

what to do with infusion complete alarm

A

contact nurse immediately

IV can clot in 4 minutes

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45
Q

IV pump - what to do if hub of catheter and tubing is leaking

A

Twist two components together and notify nursing

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46
Q

What to do if tubing has become detached

A

Hit pause and notify the nurse

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47
Q

What to do if IV has been pulled out of IV site

A

Apply firm pressure with gloved hand and gauze

Turn off IV and notify RN

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48
Q

What to do if piggyback (bag) is leaking

A

clamp it off and notify nurse

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49
Q

Intracranial pressure monitoring

A

ICP bolt or ventriculostomy

CPP (cerebral perfusion pressure)

50
Q

ICP bolt or ventriculostomy reflects what

A

the dynamic pressure relationship between the brain, CSF, and cerebreal circulation

51
Q

Normal ICP bolt or ventriculostomy finding

A

0-15mmHg
Above 20 is critical
Normal waveform have 3 peaks

52
Q

In an unimpaired brain - high ICP results in

A

automatic protective responses in an effort to maintain equilibirum

53
Q

When an ICP continues to rise despite the brain’s attempt to alleviate it 0 what happens

A

intracranial hypertension

54
Q

Uncontrolled intracranial hypertension results in what

A

secondary cerebral ischemia, brain herniation, and ultimately death of neural cells

55
Q

Anatomic ICP device positions include

A

subarachnoid space
epidural space
intraventricular space
intraparenchymal space

56
Q

ICP bolt vs. Camino bolt

A

ICP bolt you can work with

Camino bolt you cannot

57
Q

CPP is a value that considers

A

both MAP and the intracranial pressure

58
Q

MAP

A

the ability of the body to deliver blood to the brain

59
Q

Intracranial pressure

A

the resistance the system pressure must overcome to profuse the brain

60
Q

Normal CPP

A

60-150 mmHg

61
Q

CPP is calculated by

A

subtracting ICP from MAP

62
Q

Therapy implications with CPP

A

DO NOT move the bed or perform bed mobility and transfers w/o having the nurse clamp the drain
Supine exercises in stationary position are ok

63
Q

Intraaortic balloon pump (IABP) - inflates and deflates when

A

inflates in diastole, deflates in systole

64
Q

IABP assists with

A

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

65
Q

Therapist implications with IABP

A

Strict bedrest
log roll only
No hip flexion on the side the apparatus is in

66
Q

Pacemaker and defibrillator consists of what

A

placing unipolar or bipolar electrodes on the myocardium to assist with control of arrythmias

67
Q

Pacemaker used when

A

chronic dysrhythmias

68
Q

AICD used when

A

life threatening arrhythmia

69
Q

Temporary pacemaker

A

temporary pacing after heart surgery

70
Q

Therapist implications for pacemaker or defibrillator

A

No shoulder flexion above 90 degrees
Exercise limitations for UE use
No BP on that side

71
Q

Ventricular assist device - what is it

A

surgically implanted mechanical device that helps the heart pump blood

72
Q

Ventricular assist device - used for what patient population

A

advanced heart failure

73
Q

Therapist implications with VAD

A 
warm up and cool down
plug in when possible
no exercise above 90 degrees
progressive ambulation
no contact sports or activities 
avoid simultaneous bilateral shoulder flexion, abduction more than 90 degrees
74
Q

Indications for chest tubes

A

Pneumothorax
Hemothorax
Empyema
Pleural effusion

75
Q

Precautious with chest tubes

A

Avoid kinking off
Disconnecting from suction - check with nurse
Keep collection chamber dependent

76
Q

Therapist implications for chest tubes

A

Observe quantity of drainage, notify nurse if excessive
pt can be turned and mobilized after proper tube placement
MD clearance needed to disconnect from suction
UE ROM can be safely performed

77
Q

Feeding tubes - types

A 
1 Nonvented single and vented double lumen tubes
2 Nasogastric tube
3 PEG
4 Gastrostomy 
5 Jejunostomy
78
Q

Feeding tubes - Nonvented single and vented double lumen

A

preferred for enteral feedings

79
Q

Feeding tubes - nasogastric tube -

A

inserted initially - when patient requires nutrition for longer than 3-4 weeks, long term enteral access needed

80
Q

Feeding tubes - PEG (percutaneous endoscopic gastrostomy)

A

Used when long term enteral nutrition is needed

81
Q

Feeding tubes - gastrostomy

A

allows easy access for meds

can be replaced by family and patient

82
Q

Feeding tubes - jejunostomy

A

provides reduced risk for aspiration for those w/o gag reflex
Can feed immediately post op
Can be replaced by patient and family

83
Q

Therapist implications with feeding tubes - gastric bolus feedings - wait how long

A

15 to 20 minutes before placing head down flat

84
Q

True or False - all feeding tubes can usually be disconnected for the patient to be immobilized

A

TRUE

85
Q

Continuous feedings - wait time

A

none

86
Q

Feeding tube should be placed on hold or turned off when patient is below __ and restarted when patient is brought back up above ___

A

30 degrees

87
Q

Drains - Jackson Pratt

A

self contained low pressure drain with compressed bulb that expands slowly creating suction

88
Q

Drains - Jackson pratt - commonly used to

A

eliminate air or blood from the abdominal cavity or drain blood from the skull

89
Q

Drains - Hemovac

A

Another low pressure drain that is initially decompressed and then expands slowly to create suction

90
Q

Drains - hemovac - commonly used for

A

TKA and THA to drain blood

91
Q

Therapist implications for drains

A

Avoid dislodging or pulling out

Clip to patients gown or clothing to dec tugging on the site

92
Q

Dialysis is the process of

A

separating elements in a solution by diffusion across semipermeable membrane

93
Q

Types of dialysis

A

Peritoneal
Hemodialysis
Hemofiltration

94
Q

Hemodialysis

A

process by which a man made membrane helps to clear wastes from the blood, eliminate extra fluid and restore the proper balance of electrolytes

95
Q

Hemodialysis - catheter is inserted into

A

the internal jugular, subclavian or forearm for fistula (more long term access)

96
Q

Hemodialysis - lasts how long

A

3-5 hours

97
Q

Hemodialysis - blood is

A

removed, filtered, and reinserted

98
Q

Peritoneal Dialysis - used for those who

A

cannot tolerate the BP shifts from hemodialysis and is less taxing on the body

99
Q

Peritoneal dialysis - catheter is inserted

A

into the peritoneum and has a double cuff that seeds itself into the abdominal wall

100
Q

4 kinds of peritoneal dialysis

A

Intermittent (IPD)
Continuous Ambulatory (CAPD)
Cyclic continuous (CCPD)
Equilibrium (EPD)

101
Q

Intermittent Peritoneal Dialysis

A

warm dialysate is infused rapidly, allowed to dwell, and then drained
Each cycle is 10 min
Lasts 8-48 hrs, 3-7 days

102
Q

Continuous ambulatory dialysis

A

infused (10 min) allowed to dwell (4-8 hrs) and then drains (10 min)
Lasting 3-4 times per day, 1 night

103
Q

Advantage to CAPD

A

Closely approximates the normal functioning homeostasis

No special equipment needed

104
Q

Cyclic continuous peritoneal dialysis

A

Combination of IPD at night and CAPD during the day
Lasting 3-4 times per night lasting 8 hours
Dec chance of infection

105
Q

Equilibrium peritoneal dialyssi

A

continuous - for hospitalized, non ambulatory patients

106
Q

Complications of peritoneal dialysis - mechanical

A

Perforation of viscous, leakage, clots and obstruction of flow

107
Q

Complications of peritoneal dialysis - infection

A

peritonitis, infection of skin interface and catheter

108
Q

Complications of peritoneal dialysis - Cardiovascular

A

HTN, pulmonary edema, arrhythmias

109
Q

Complications of peritoneal dialysis - Pulmonary

A

Atelectasis, pleural effusion, pneumonia

110
Q

Complications of peritoneal dialysis - Metabolic

A

hyperglycemia, hypoalbuminemia

111
Q

Complications of peritoneal dialysis - Misc

A

seizures, electrolyte disorders, peritoneal sclerosis, hypothyroidism

112
Q

Therapist implications with dialysis

A

Avoid dislodging or pulling out
Dont flex hip more than 45 if femoral port
Bed may need to be elevated to allow for dependent drainage

113
Q

Therapist implications with dialysis - pt may exerpience

A

fatigue, dehydration, electrolyte imbalance

Long term - joint swelling, subchondral bone cysts, chronic arthralgias, muscle cramps

114
Q

Hemofiltration dialysis

A

dilutes blood and decreases blood serum

Often used in conjunction with hemodialysis

115
Q

Four kinds of hemofiltration

A

CAVHD
CVVH
CVVHD
CVVHDF

116
Q

Hemofiltration - CAVHD - Continuous arteriovenous hemofiltration - inserted where

A

Inserted in subclavian, jugular, femoral veins

117
Q

CVVH - continuous veno venous hemofiltration - functions hwo

A

removes mid sized molecules
improves sepsis and volume overloaded patients
Replacement electrolyte soluation is required to maintain hemodyanmic stability

118
Q

CVVHD - continuous ven venous hemodialysis

A

continuous diffuse dialysis

119
Q

CVVHDF!!! - Continuous veno venous hemodiafiltration

A

Mos tpopular in ICU
Combines convective and diffuse dialysis
Both small and middle sized molecules are cleared
Dialysate and replacement fluids are required

120
Q

Urinary catheter and renal catheter AKA

A

foley catheter

121
Q

Urinary catheter is held in with

A

a bulb

122
Q

Therapist implications with foley catheter

A

dont hold line or bad above insertion site
dont dislodge tube
clip catheter to patient clothes
rectal - be careful not to sheer on surface they are on

Semester 5 PMCP Exam 2 (6 decks)

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