Procedure Unitek College Fremont – Transition

- Administered in the epidural space via a catheter. - Usually used for postoperative analgesia.

- Administered via subarachnoid space, or one of the ventricles of the brain.

- Administered infusion directly to the bone marow. - Commonly used in infants and toddlers.

- Commonly used in chemotherapeutics agents, insulin, and antibiotics directly to peritoneal cavity.

- Commonly used in chemotherapeutics agents directly into the pleural space.

- Directly into the arteries.

- Directly into the cardiac muscle.

Injected directly into a joint.

*High-fowlers *Measurement length from the tip of the nose, to the ear lobe, and xyphoid process. *Use water soluble lubricant, because it dissolves if the tube accidentally enters the lungs. *Directing the tubes and avoid the turbinates along the lateral wall. *Upon reaching oropharnyx, asked client to tile head forward and encouraged client to drink water (if able) or ice chips. *Tilting head facilitates passage of the tube into the posterior pharynx and esophagus rather than in to the larynx. *Swallowing moves the epiglottis over the opening to the larynx. *Advance tube 5-10cm (2-4 in.) with each swallow until indicated length was inserted. *Advancing the tube with each swallow eases the insertion. *Proper tube placement avoids harmful complications of NG tube placement like aspirations, punctured stomach lining. Indication of placements: *pH level is 1.5 to 3.5 in stomach *Auscultation <---not reliable. *X-ray **Nasogastric decompresision is indicated to relieve vomiting and abdominal distention, common manifestations of paralytic ileus. **Sump tube is designed for continuous suctioning because it has a vent lumen that allows the tube to float freely and keeps it from adhering to or damaging the gastric mucosa. **Elevated PT/PTT levels are contraindication to nasogastric tube insertion (increase risk of bleeding or hemorrhage)

*110-120mm/hg *100% oxygenation is required to avoid hypoxia. *Suctioning causes oxygen depletion. *Checking patency of the equipment prior use is an integral part for safety to avoid causing harm to the client. (Using saline solution). *Maintain adequate amount of oxygen by hyperventilating the lungs prior, in between and at the end of suctioning. *Quickly but gently inserting catheter without applying suction. *Insert catheter about 5 inches or until client coughs before applying suction for maximum of 10 seconds only. *Applying suction while inserting the catheter can cause irritation in the trach lining. *Dispose and replace supplies for next suction. *No more than 2 times. **Intermittent suctioning. **Insert the suction catheter until you meet resistance at the carina or until the patient coughs. Then pull it back 1 cm (1/2 inch) and slowly withdraw it while applying intermittent suction and using a rotating motion. **The mouth and the pharynx house more bacteria than the trachea does. So, suction the trachea before you suction the pharyngeal area. **Immediately withdraw the suction catheter and administer oxygen and breaths from a manual resuscitation bag as needed. In an emergency, you can deliver oxygen directly through the catheter by disconnecting the suction and attaching oxygen at the prescribed flow rate.

*Allow client to rest and restore oxygenation prior to performing trach care. *Previous suctioning causes exhaustion although it aids in breathing properly by removing the clogged sputum. *Open away from you *Maintain 1 inch sterile field. *Do not cross-over sterile field. *Gently pulling it outward toward self in line with its curvature. *Recognize for signs of infection. *Any type of incisions puts the client at risk for infection. *Apply sterile dressing without contamination the inner portion. *Regular or un-sterile dressing can cause the threads to loose and possibly stick into the incision which then may cause infection. *Tracheostomy may accidentally come out if not secured properly when client coughs. *Tying the neck tie too tightly can cause oxygen depletion, pain and discomfort. **It is not safe to cut a gauze pad and use it with a tracheostomy tube. The patient could aspirate fibers from the gauze, resulting in an infection or an abscess in the trachea. Use commercially prepared tracheostomy dressings or a folded 4 x 4 gauze pad instead. **Tie the ends of the twill tape in a double square knot near the flange of the tracheostomy tube. Cut off any long ends, leaving approximately 1 to 2 cm (0.5 inch). Tying the ends this way helps prevent slippage and loosening; leaving a short amount on the ends keeps the knots from becoming untied.

*Making sure that the balloon is working properly prior insertion to avoid harming the patient. *1-2 in. for females *6-7 in. for males *Clean the meatus *Front to back *Hang the bag below. Not touching the floor. **If no urine appears and you have checked that the catheter is not inside the vagina, continue advancing the catheter slowly and gently until urin appears. Then advance the catheter another 1-2 inches to be sure the tip is fully inside the bladder before inflating the balloon. **DO NOT FORCE IT IF YOU MEET RESISTANCE. **Obtaining sample from a closed system through the port. Thoroughly cleanse with aseptic solution before obtaining specimen. **Use the least invasive action first when observing obstructions. The situation you may encounter is kinks or obstructions in the tubing. Examining the path of the urine from the patient to the bag is a good way to check for this. **During irrigation, when introducing fluid into the bladder that is significantly below body temperature, bladder spasm often occurs. **

*When placing items on a sterile field, small items such as gauze pads or sponges can be dropped from 6 to 8 inches above the sterile field. ***Maintain 1 inch sterile field.