Tubes and Lines Flashcards
Arterial lines usually placed where
femoral, radial, or brachial arteries
Arterial line permits what
repetitive arterial blood samples
Arterial lines measure what
arterial blood pressure
Most accurate readings from arterial lines are in what position
limb straight and level with the heart
Normal for systolic and diastolic for arterial line readings
Sys = 80 to 180 Dias = 40-110
What to keep in mind with femoral arterial line (ROM restriction)
no hip flexion past 45 degrees with rigid one
Therapist implications - arterial line
Avoid kinking off
Turn only 90 deg in SL
Careful ROM to prox joints
Central venous catheter - inserted most commonly through what
subclavian vein
internal jugular
femoral vein
Tip of the central venous catheter enters what
the SVC
Central venous catheter measures what
Provides info about what
right arterial pressure
About the body’s volume status and RV function
Normal central venous catheter findings
0 to 6
What are long term central venous catheters called
Hickman Groshong catheters
Therapist implications with central venous catheter
Dont roll patient to side catheter is on - might cause PVC
Triple lumen
IV lines that emerge into one main vein
Provides access to pt for large dose of meds, fluids, and blood for parenteral nutrition
Pulmonary artery catheter AKA
Swan Ganz
IS YELLOW!
Pulmonary artery catheter is passed through where
the right side of the heart into a pulmonary branched vessel
Pulmonary artery catheter provides what
an immediate profile of cardiac function by measuring pulmonary artery pressure and CO
Pulmonary artery catheter approximates
left ventricular end - diastolic pressure - preload
Normal measure for pulmonary artery catheter
5-15 mmHg
Precautions with measure of pulmonary artery catheter greater than 12mmHg
do not place them in a horizontal position because venous return will increase
Therapist implications with PA catheter - these patients are frequently
restricted to bed rest because of risk of pulmonary thrombosis, jugular vein thrombosis, PA rupture, hemorrhage, sepsis and arrhythmia
Peripherally Inserted Central Catheter (PICC) provides what
alternate means of vascular access
PICC - use is long or short term?
Can be used short or long term
PICC - can it be used at home
Yes, appropriate for home IV therapy
PICC - catheter is inserted by
venipuncture of the basilic, medial cubital or cephalic vein, at or above the antecubital space
PICC - tip advances to where
lower 1/3 of SVC
How can you tell if patient has a PICC - description
Tiny - has blue of white butterfly taped down
Therapist implications with PICC (ROM)
Do not flex shoulder or elbow more than 90
Could cause arrhythmia
Avoid dislodging
Intravenous catheters are used for what short term
to provide short term access into the body for blood products, IV fluids, and meds
Intravenous catheters are used for what long term
access for IV antibiotics, total parenteral nutrition, dialysis or chemo
Intravenous catheters will monitor what
central venous pressure or right atrial pressure, pulmonary artery pressure, wedge pressure, and temperature
Midline catheter - description
looks like PICC line but is not sutured in like the PICC line is
Midline catheter is usually located
in the antecubital fossa
Intravenous catheter - methods of placement - PICC, midline, IV lines placed by who
Nursing or IV team
PICC and midline are xrayed after
Intravenous catheter - methods of placement - Hickman, Swan Ganz, and central venous lines are usually placed by who
physicians at bedside, stitched into place and then x-rayed after placement
Therapist implications with IV catheter
No BP in that extremity
Do not dislodge
Peripheral IVs - long or short term use
short term use 24-48 hours
Peripheral IVs - placed where
anywhere from hand to upper arm to feet and thighs
Therapist implications for peripheral IV
Do not dislodge
No BP in that extremity
Cautious with elbow flexion
Intravenous pumps - common alarms
Low battery
Occlusion
Air in line
Infusion complete
What to do with lwo battery alarm
plug into wall outlet
Loses all settings if battery dies
What to do with occlusion alarm
Adjust the line and stop mvmnt to stop occlusion
Push appropriate channel and then push start
What to do with air in line alarm
contact the nurse
what to do with infusion complete alarm
contact nurse immediately
IV can clot in 4 minutes
IV pump - what to do if hub of catheter and tubing is leaking
Twist two components together and notify nursing
What to do if tubing has become detached
Hit pause and notify the nurse
What to do if IV has been pulled out of IV site
Apply firm pressure with gloved hand and gauze
Turn off IV and notify RN
What to do if piggyback (bag) is leaking
clamp it off and notify nurse
Intracranial pressure monitoring
ICP bolt or ventriculostomy
CPP (cerebral perfusion pressure)
ICP bolt or ventriculostomy reflects what
the dynamic pressure relationship between the brain, CSF, and cerebreal circulation
Normal ICP bolt or ventriculostomy finding
0-15mmHg
Above 20 is critical
Normal waveform have 3 peaks
In an unimpaired brain - high ICP results in
automatic protective responses in an effort to maintain equilibirum
When an ICP continues to rise despite the brain’s attempt to alleviate it 0 what happens
intracranial hypertension
Uncontrolled intracranial hypertension results in what
secondary cerebral ischemia, brain herniation, and ultimately death of neural cells
Anatomic ICP device positions include
subarachnoid space
epidural space
intraventricular space
intraparenchymal space
ICP bolt vs. Camino bolt
ICP bolt you can work with
Camino bolt you cannot
CPP is a value that considers
both MAP and the intracranial pressure
MAP
the ability of the body to deliver blood to the brain
Intracranial pressure
the resistance the system pressure must overcome to profuse the brain
Normal CPP
60-150 mmHg
CPP is calculated by
subtracting ICP from MAP
Therapy implications with CPP
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
Intraaortic balloon pump (IABP) - inflates and deflates when
inflates in diastole, deflates in systole
IABP assists with
circulation of blood through the body and reduces work of the heart
Therapist implications with IABP
Strict bedrest
log roll only
No hip flexion on the side the apparatus is in
Pacemaker and defibrillator consists of what
placing unipolar or bipolar electrodes on the myocardium to assist with control of arrythmias
Pacemaker used when
chronic dysrhythmias
AICD used when
life threatening arrhythmia
Temporary pacemaker
temporary pacing after heart surgery
Therapist implications for pacemaker or defibrillator
No shoulder flexion above 90 degrees
Exercise limitations for UE use
No BP on that side
Ventricular assist device - what is it
surgically implanted mechanical device that helps the heart pump blood
Ventricular assist device - used for what patient population
advanced heart failure
Therapist implications with VAD
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
Indications for chest tubes
Pneumothorax
Hemothorax
Empyema
Pleural effusion
Precautious with chest tubes
Avoid kinking off
Disconnecting from suction - check with nurse
Keep collection chamber dependent
Therapist implications for chest tubes
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
Feeding tubes - types
1 Nonvented single and vented double lumen tubes 2 Nasogastric tube 3 PEG 4 Gastrostomy 5 Jejunostomy
Feeding tubes - Nonvented single and vented double lumen
preferred for enteral feedings
Feeding tubes - nasogastric tube -
inserted initially - when patient requires nutrition for longer than 3-4 weeks, long term enteral access needed
Feeding tubes - PEG (percutaneous endoscopic gastrostomy)
Used when long term enteral nutrition is needed
Feeding tubes - gastrostomy
allows easy access for meds
can be replaced by family and patient
Feeding tubes - jejunostomy
provides reduced risk for aspiration for those w/o gag reflex
Can feed immediately post op
Can be replaced by patient and family
Therapist implications with feeding tubes - gastric bolus feedings - wait how long
15 to 20 minutes before placing head down flat
True or False - all feeding tubes can usually be disconnected for the patient to be immobilized
TRUE
Continuous feedings - wait time
none
Feeding tube should be placed on hold or turned off when patient is below __ and restarted when patient is brought back up above ___
30 degrees
Drains - Jackson Pratt
self contained low pressure drain with compressed bulb that expands slowly creating suction
Drains - Jackson pratt - commonly used to
eliminate air or blood from the abdominal cavity or drain blood from the skull
Drains - Hemovac
Another low pressure drain that is initially decompressed and then expands slowly to create suction
Drains - hemovac - commonly used for
TKA and THA to drain blood
Therapist implications for drains
Avoid dislodging or pulling out
Clip to patients gown or clothing to dec tugging on the site
Dialysis is the process of
separating elements in a solution by diffusion across semipermeable membrane
Types of dialysis
Peritoneal
Hemodialysis
Hemofiltration
Hemodialysis
process by which a man made membrane helps to clear wastes from the blood, eliminate extra fluid and restore the proper balance of electrolytes
Hemodialysis - catheter is inserted into
the internal jugular, subclavian or forearm for fistula (more long term access)
Hemodialysis - lasts how long
3-5 hours
Hemodialysis - blood is
removed, filtered, and reinserted
Peritoneal Dialysis - used for those who
cannot tolerate the BP shifts from hemodialysis and is less taxing on the body
Peritoneal dialysis - catheter is inserted
into the peritoneum and has a double cuff that seeds itself into the abdominal wall
4 kinds of peritoneal dialysis
Intermittent (IPD)
Continuous Ambulatory (CAPD)
Cyclic continuous (CCPD)
Equilibrium (EPD)
Intermittent Peritoneal Dialysis
warm dialysate is infused rapidly, allowed to dwell, and then drained
Each cycle is 10 min
Lasts 8-48 hrs, 3-7 days
Continuous ambulatory dialysis
infused (10 min) allowed to dwell (4-8 hrs) and then drains (10 min)
Lasting 3-4 times per day, 1 night
Advantage to CAPD
Closely approximates the normal functioning homeostasis
No special equipment needed
Cyclic continuous peritoneal dialysis
Combination of IPD at night and CAPD during the day
Lasting 3-4 times per night lasting 8 hours
Dec chance of infection
Equilibrium peritoneal dialyssi
continuous - for hospitalized, non ambulatory patients
Complications of peritoneal dialysis - mechanical
Perforation of viscous, leakage, clots and obstruction of flow
Complications of peritoneal dialysis - infection
peritonitis, infection of skin interface and catheter
Complications of peritoneal dialysis - Cardiovascular
HTN, pulmonary edema, arrhythmias
Complications of peritoneal dialysis - Pulmonary
Atelectasis, pleural effusion, pneumonia
Complications of peritoneal dialysis - Metabolic
hyperglycemia, hypoalbuminemia
Complications of peritoneal dialysis - Misc
seizures, electrolyte disorders, peritoneal sclerosis, hypothyroidism
Therapist implications with dialysis
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
Therapist implications with dialysis - pt may exerpience
fatigue, dehydration, electrolyte imbalance
Long term - joint swelling, subchondral bone cysts, chronic arthralgias, muscle cramps
Hemofiltration dialysis
dilutes blood and decreases blood serum
Often used in conjunction with hemodialysis
Four kinds of hemofiltration
CAVHD
CVVH
CVVHD
CVVHDF
Hemofiltration - CAVHD - Continuous arteriovenous hemofiltration - inserted where
Inserted in subclavian, jugular, femoral veins
CVVH - continuous veno venous hemofiltration - functions hwo
removes mid sized molecules
improves sepsis and volume overloaded patients
Replacement electrolyte soluation is required to maintain hemodyanmic stability
CVVHD - continuous ven venous hemodialysis
continuous diffuse dialysis
CVVHDF!!! - Continuous veno venous hemodiafiltration
Mos tpopular in ICU
Combines convective and diffuse dialysis
Both small and middle sized molecules are cleared
Dialysate and replacement fluids are required
Urinary catheter and renal catheter AKA
foley catheter
Urinary catheter is held in with
a bulb
Therapist implications with foley catheter
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